Health Care Reform:Medicare/Medicaid/Education

There is a huge amount of talk (containing very few facts) about the 2010 Health Care Reform Bill. Here we will to try to give facts about how this Bill affects you. This is also a place for people to give their opinions about how this Bill will affect them personally.
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Health Care Reform:Medicare/Medicaid/Education

Postby dlcnurse » Sat Apr 24, 2010 3:16 am

Part of the current health care reform plan giving a review of the Health Care and Education Reconciliation Act of 2010

Health Care and Education Reconciliation Act of 2010 - Title I: Coverage, Medicare, Medicaid, and Revenues - Subtitle A: Coverage - (Sec. 1001) Amends Internal Revenue Code provisions added by the Patient Protection and Affordable Care Act (PPACA) to revise the formula for calculating the refundable tax credit for premium assistance for coverage under a qualified health plan by establishing a sliding scale from the initial to the final premium percentage for individuals and families with household incomes up to 400% of the federal poverty line. Requires adjustments, after 2014 and after 2018, of the initial and final premium percentages to reflect the excess (if any) of the rate of premium growth over the rate of growth of income and the consumer price index.

Reduces from 9.8% to 9.5% of a taxpayer's household income the maximum amount an employee's required contribution to an employer-sponsored plan may be for such employee to be treated as eligible for employer-sponsored minimum essential coverage.

Increases the percentage of employer cost sharing for the out-of-pocket expenses of individuals with household incomes between 100% and 400% of the federal poverty line.

(Sec. 1002) Revises the provisions setting forth penalties to be imposed on individuals who decline to purchase health care coverage by: (1) lowering the maximum penalty amount from $495 to $325 in 2015 and from $750 to $695 in 2016; and (2) increasing the penalty rates based on taxpayer household income for taxable years beginning in 2014 and 2015 and for taxable years beginning after 2015.

(Sec. 1003) Revises the provisions setting forth penalties to be imposed on employers with 50 or more employees who decline to offer employees health care coverage to allow an exemption for the first 30 employees (including part-time employees) when calculating the penalty. Increases the applicable penalty amount per employee to $2,000. Eliminates the assessment on large employers with extended waiting periods for enrollment in employer-sponsored plans.

(Sec. 1004) Modifies the definition of "modified adjusted gross income" for purposes of the tax credit for premium assistance and the individual responsibility requirement for purchasing health care coverage.

Extends the exclusion from gross income for employer-provided health care coverage to adult children up to age 26.

Requires Exchanges that offer health care plans to provide the Secretary of the Treasury and taxpayers with specified information, including information about the level of coverage, the total premium for coverage, and the aggregate amount of any advance payment of the premium assistance tax credit.

Amends title XIX (Medicaid) of the Social Security Act to allow a disregard of 5% of modified adjusted gross income for purposes of determining eligibility for medical assistance.

(Sec. 1005) Establishes a Health Insurance Reform Implementation Fund within the Department of Health and Human Services (HHS) and makes appropriations to the Fund for the administrative costs of carrying out PPACA and this Act.

Subtitle B: Medicare - (Sec. 1101) Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of HHS to provide a one-time $250 rebate in 2010 to all Medicare part D enrollees who enter the Medicare part D coverage gap (also known as the Medicare donut hole, the difference between the standard initial coverage limit and the catastrophic or out-of-pocket coverage threshold for which the Medicare beneficiary is financially responsible).

Amends PPACA to: (1) delay until January 1, 2011, the deadline for establishment of a Medicare coverage gap discount program, as well as the effective date of the requirement that a part D drug manufacturer participate in it; and (2) repeal the increase by $500 in the 2010 standard initial coverage limit (thus restoring the provisions in effect before enactment of PPACA).

Amends SSA title XVIII, as amended by PPACA, to reduce the coinsurance percentage for covered brand-name and generic drugs to 25% by 2020 (thus closing the donut hole with 75% discounts).

Revises the growth rate of the out-of-pocket cost threshold.

(Sec. 1102) Amends PPACA to repeal: (1) certain provisions concerning Medicare Advantage (MA) payments, benchmarks, and capitation rates; and (2) a requirement that the Secretary analyze the differences in coding patterns between MA and the original Medicare fee-for-service programs, and incorporate the results into risk scores for 2014 and subsequent years.

Amends SSA title XVIII to freeze MA payments in 2011. Reduces MA benchmarks relative to current levels, varying them from 95% of Medicare spending in high-cost areas to 115% of Medicare spending in low-cost areas. Creates an incentive system to increase payments to high-quality plans by at least 5%. Extends the authority of the Centers for Medicare & Medicaid Service to adjust MA risk scores for observed differences in coding patterns relative to fee-for-service.

Repeals the Comparative Cost Adjustment Program under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

(Sec. 1103) Requires MA plans whose medical loss ratios are not at least .85 to remit to the Secretary an amount equal to a specified percentage of plan revenue. Requires the Secretary to: (1) prohibit enrollment in such a plan of new enrollees for three consecutive contract years; and (2) terminate the Medicare+Choice contract if the plan fails to have a .85 medical loss ratio for five consecutive contract years.

(Sec. 1104) Amends SSA title XVIII (Medicare), as amended by PPACA, with respect to specified reductions to Medicare disproportionate share hospital (DSH) payments for FY2015 and ensuing fiscal years, especially to subsection (d) hospitals, to reflect lower uncompensated care costs relative to increases in the number of insured. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system [IPPS] when providing covered inpatient services to eligible beneficiaries.)

Advances the beginning of such reductions from FY2015 to FY2014. Revises the reduction formula to lower the reduction scheduled to occur over ten years.

(Sec. 1105) Revises the hospital market basket reduction applicable to payments to inpatient hospitals, long-term care hospitals, inpatient rehabilitation facilities, psychiatric hospitals, and outpatient hospitals.

(Sec. 1106) Postpones from August 1, 2010, to December 31, 2010, the date by which physician-owned hospitals must have a provider agreement in order to participate in Medicare under a rural provider and hospital exception to the physician-ownership or -investment prohibition if they also meet certain requirements addressing conflicts of interest, bona fide investments, patient safety issues, and expansion limitations.

Modifies the expansion limitation imposed on such a rural hospital under which the number of operating rooms, procedure rooms, and beds for which the hospital is licensed at any time on or after the enactment of PPACA is no greater than the number of such rooms and beds for which the hospital is licensed as of such date. Allows an exception to the expansion limitation for a high Medicaid hospital that treats the highest percentage of Medicaid patients in their county (and is not the sole hospital in the county).

(Sec. 1107) Revises the special rule in the physician fee schedule for imaging services, in particular the PPACA adjustment in the practice expense relative value units with respect to advanced diagnostic imaging services to reflect a higher presumed utilization rate. Replaces the multiyear phase-in of the assumed utilization rate from 50% to 75% with a flat 75% rate for 2011 and subsequent years.

(Sec. 1108) Modifies the employee wage and rent portions of the practice expense geographic index adjustment for 2010 and subsequent years. Requires such portions to reflect 1/2 (instead of 3/4) of the difference between the relative costs of employee wages and rents in each of the different fee schedule areas and the national average of such employee wages and rents.

(Sec. 1109) Directs the Secretary to provide for a specified payment for FY2011 and FY2012 to qualifying subsection (d) hospitals located in a county that ranks, based upon age, sex, and race adjusted spending per enrollee for Medicare parts A and B benefits, within the lowest quartile of such counties in the United States.

Subtitle C: Medicaid - (Sec. 1201) Amends SSA title XIX (Medicaid), as amended by PPACA, to repeal the permanent 100% federal matching rate (federal medical assistance percentage [FMAP]) for Nebraska for the Medicaid costs of newly eligible mandatory individuals (expansion populations). Provides federal Medicaid matching payments for the costs of services to expansion populations at the following rates in all states: (1) 100% in 2014, 2015, and 2016; (2) 95% in 2017; (3) 94% in 2018; (4) 93% in 2019; and (5) 90% thereafter.

Reduces, in the case of expansion states, the state share of the costs of covering nonpregnant childless adults by 50% in 2014, 60% in 2015, 70% in 2016, 80% in 2017, 90% in 2018.

(Sec. 1202) Requires that Medicaid payment rates to primary care physicians (family medicine, general internal medicine, or pediatric medicine) for furnishing primary care services in 2013 and 2014 be at least 100% of Medicare payment rates under both fee-for-service plans and managed-care plans.

Requires a 100% FMAP for the costs to states of meeting this requirement.

(Sec. 1203) Lowers the reduction in federal Medicaid DSH payments and advances the reductions to begin in FY2014.

Directs the Secretary to develop a methodology for reducing federal DSH allotments to all states in order to achieve the mandated reductions.

Extends through FY2013 the federal DSH allotment for a state that has a $0 allotment after FY2011.

(Sec. 1204) Authorizes Puerto Rico, Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands to elect to operate a Health Benefits Exchange. Increases federal Medicaid payments to such territories. Raises the caps on federal Medicaid funding for each of the territories.

(Sec. 1205) Postpones from October 1, 2010, until October 1, 2011, the effective date of the Community First Choice option established for state Medicaid programs to offer home and community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases.

(Sec. 1206) Revises the definition of a new formulation of an existing drug, for purposes of applying the additional rebate, to specify a line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form of the drug.

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Re: Health Care Reform:Medicare/Medicaid/Education

Postby DennisQ » Tue Apr 12, 2011 12:38 pm

There are so many little changes and adjustments in the law. I can see how it can be quite confusing for Americans. I can also see how many parts can be misinterpreted by the media and the public. I wish there was a way to plug in your or your family's information and see how the law will affect you.
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Re: Health Care Reform:Medicare/Medicaid/Education

Postby dlcnurse » Wed Apr 13, 2011 1:49 am

Unfortunately, the changes are not done. It is the wording of each section, the interpretion, political gains/losses, and the government. What I do see is that the public has no idea of what is to come. The cuts that they are discussing at this point can and will be detrimental to the senior citizens who currently exist on a meager amount to live. Everything is going to a health and wellness type program which exemplifies those with minimal health issues. Those that have chronic issues, are on life long medications, treatments etc. will be the hardest hit with th passage of the new health care bill.
Insurance companies will still be dictating, co-pays will go up, major procedures and tests will not be approved, out of pocket expense will increase for everyone.
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