The following summary of the provisions in the Patient Protection and Affordable Care Act is based on PPACA summaries from gov and dpc.and is fact checked for accuracy against the law itself, the Patient Protection and Affordable Care Act HR390. Prohibits all plans from rescinding coverage except in instances of fraud or misrepresentation. Requires Exchanges to award grants to Navigators that educate the public about qualified health plans, distribute information on enrollment and tax credits, facilitate enrollment, and provide referrals on grievances, complaints, or questions. Requires insurers to pool the risk of all enrollees in all plans (except grandfathered plans) in each market, regardless of whether plans are offered through Exchanges. Requires Exchanges to keep an accurate accounting of all expenditures and submit annual accounting reports to the Secretary. Creates performance bonus payments based on a plan’s level of care coordination and care management and achievement on quality rankings. Prohibits Medicare Advantage plans from charging beneficiaries cost sharing for covered services that is greater than what is charged under the traditional fee-for-service program. Application of coding intensity adjustment during MA payment transition. Simplification of annual beneficiary election periods. Provides extra time for CMS, Medicare Advantage plans and prescription drug plans to process enrollment paperwork during annual enrollment periods and eliminates a duplicative open enrollment period for Medicare Advantage plans. Extension for specialized MA plans for special needs individuals. Requires the HHS Secretary to support emergency medicine research, including pediatric emergency medical research. Such services would include diagnostic, therapy and counseling services, and prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration for cessation of tobacco use by pregnant women. Incentives for prevention of chronic diseases in Medicaid. Authorizes States to purchase adult vaccines under CDC contracts. Codifies the existing national center and establishes several regional centers for health workforce analysis to collect, analyze, and report data related to Title VII (of the Public Health Service Act) primary care workforce programs. In some cases additional rules have changed parts of the law. Requires the offering of only qualified health plans though Exchanges to Members of Congress and their staff. Requires Exchanges to cooperate with Secretarial investigations and allows for Secretarial audits of Exchanges. Requires the Secretary to conduct a study on the need for additional Medicare payments for certain urban Medicare-dependent hospitals paid under the inpatient prospective payment system. Provides a four-year transition to new benchmarks beginning in 2011. Requires plans that provide extra benefits to give priority to cost sharing reductions, wellness and preventive care, and then benefits not covered under Medicare. Extends HHS authority to adjust risk scores in Medicare Advantage for observed differences in coding patterns relative to traditional fee-for-service. Allows beneficiaries to disenroll from a Medicare Advantage plan and return to the traditional fee-for-service program from January 1 to March 15 of each year. Extends the SNP program through 2013 and requires SNPs to be NCQA approved. Technical correction to MA private fee-for-service plans. Making senior housing facility demonstration permanent. Allows demonstration plans that serve residents in continuing care retirement communities to operate under the Medicare Advantage program. This section would also prohibit cost-sharing for these services. The Secretary would award grants to States to provide incentives for Medicaid beneficiaries to participate in programs providing incentives for healthy lifestyles. Currently, 23 States purchase vaccines under CDC contracts. Establishes a national commission tasked with reviewing health care workforce and projected workforce needs. Competitive grants are created for the purpose of enabling State partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels. The centers will coordinate with State and local agencies collecting labor and workforce statistical information and coordinate and provide analyses and reports on Title VII to the Commission. Requires health insurance issuers in the small group and individual markets to include coverage which incorporates defined essential benefits, provides a specified actuarial value, and requires all health plans to comply with limitations on allowable cost-sharing. Assured Availability of Varied Coverage through the Exchanges. Establishes a Ready Reserve Corps within the Commissioned Corps for service in times of national emergency. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship. Authorizes funding over three years to establish new training opportunities for direct care workers providing long-term care services and supports. Reinstates dental funding in Title VII of the Public Health Service Act. Alternative dental health care provider demonstration project. Geriatric education and training; career awards; comprehensive geriatric education. Mental and behavioral health education and training grants. Cultural competency, prevention, and public health and individuals with disabilities training. A State may elect to require coverage of abortions beyond those allowed by Hyde only if no Federal funds are used for this coverage. Abortions currently permitted by Hyde shall be covered in the Community Health Insurance Option to the same extent as they are under Medicaid. Training in general, pediatric, and public health dentistry. Strengthens language for accredited Nurse Midwifery programs to receive advanced nurse education grants in Title VIII of the Public Health Service Act. Each health insurance issuer must accept every employer and individual in the State that applies for coverage, permitting annual and special open enrollment periods for those with qualifying lifetime events. Authorizes a 10-State demonstration to apply such a program in the individual market. The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill. Defines the small group market as the market in which a plan is offered by a small employer that employs 1-100 employees. Strengthens the health care safety-net by creating a million grant program administered by HRSA to support nurse-managed health clinics.
Indexes the limits and deductible amounts by the percentage increase in average per capita premiums. For the individual and small group markets, requires one of the following levels of coverage, under which the plan pays for the specified percentage of costs: Bronze: 60 percent Silver: 70 percent Gold: 80 percent Platinum: 90 percent In the individual market, a catastrophic plan may be offered to individuals who are under the age of 30 or who are exempt from the individual responsibility requirement because coverage is unaffordable to them or they have a hardship. A qualified health plan would determine whether it will cover: no abortions, only those abortions allowed under Hyde (rape, incest and life endangerment), or abortions beyond those allowed by Hyde. Adds faculty at nursing schools as eligible individuals for loan repayment and scholarship programs.
If you are looking for a specific title or provision please use the basic find command on your browser. The first section of the PPACA contains amendments to the Public Health Service Act of 1944. Requires States to implement these standards by 2014. Extends the existing outpatient hold harmless provision through the end of FY2010 and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of FY2010. Reinstates the policy included in the Medicare Modernization Act of 2003 (P. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals from July 1, 2010 to July 1, 2011. Extends the program for one year and expands eligible sites to additional States and additional rural hospitals. Extends the Medicare-dependent hospital program by one year through October 1, 2012. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Improvements to the demonstration project on community health integration models in certain rural counties. This provision would direct the Secretary to improve payment accuracy through rebasing home health payments starting in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. This provision would require the Secretary to update Medicare hospice claims forms and cost reports by 2011. Also requires an evaluation of Medicare Advantage risk adjustment for chronically ill populations. Under this program, CDC will provide grants to States to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions.
Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of health care Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title VIIII Revenue provisions Title X Reauthorization of the Indian Health Care Improvement Act Sec. If the Secretary determines before 2013 that a State will not have an Exchange operational by 2014, or will not implement the standards, requires the Secretary to establish and operate an Exchange in the State and to implement the standards. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. It would also require HHS to study whether certain urban hospitals should qualify for the MDH program. Expands the program providing a temporary adjustment to inpatient hospital payments for certain low-volume hospitals through FY2012 and would modify eligibility requirements regarding distance from another facility and number of eligible discharges. The Medicare Improvements for Patients and Providers Act (MIPPA, P. 110-275) authorized a demonstration project that will allow eligible rural entities to test new models for the delivery of health care services in rural areas. Med PAC study on adequacy of Medicare payments for health care providers serving in rural areas. Technical correction related to critical access hospital services. Extension of and revisions to Medicare rural hospital flexibility program. The provision would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments and would reinstate an add-on payment for rural home health providers from April 1, 2010 through 2015. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy in FY2013. Improvement to Medicare disproportionate share hospital (DSH) payments. Directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare, including services that have experienced high growth rates. Modification of equipment utilization factor for advanced imaging services. Directs the Secretary to study whether existing cancer hospitals that are exempt from the inpatient prospective payment system have costs under the outpatient prospective payment system (OPPS) that exceed costs of other hospitals, and to make an appropriate payment adjustment under OPPS based on that analysis. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits. This initiative would amend the Fair Labor Standard Act to require employers to provide break time and a place for breastfeeding mothers to express milk. Research on optimizing the delivery of public health services. Establishes a program at the CDCthat awards grants to assist State, local, and tribal public health agencies in improving surveillance for and responses to infectious diseases and other conditions of public health importance.
These independent offices will assist consumers with filing complaints and appeals, educate consumers on their rights and responsibilities, and collect, track, and quantify consumer problems and inquiries. Ensuring that consumers get value for their dollars. Immediate access to insurance for people with a preexisting condition. Establishes that premiums in the individual and small group markets may vary only by family structure, geography, the actuarial value of the benefit, age (limited to a ratio of 3 to 1), and tobacco use (limited to a ratio of 1.5 to 1). In addition, this bill does not affect State or Federal laws, including section 1867 of the Social Security Act (EMTALA), requiring health care providers to provide emergency services. Before 2016, a State may limit the small group market to 50 employees. By 2014, requires States to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans and includes a SHOP Exchange for small businesses. Creates an interagency council dedicated to promoting healthy policies at the Federal level. Preventive Services Task Force is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness of clinical preventive services such as colorectal cancer screening or aspirin to prevent heart disease, and develops recommendations for their use. Education and outreach campaign regarding preventive benefits. Increases and extends the authorization of appropriations for the National Health Service Corps scholarship and loan repayment program for FY10-15.
The Secretary shall award grants to States to enable them (or the Exchange) to establish, expand, or provide support for offices of health insurance consumer assistance or health insurance ombudsman programs. The rights and obligations of employees and employers under Title VII of the Civil Rights Act of 1964 would also not be affected by the bill. Defines the large group market as the market in which a plan is offered by a large employer that employs more than 100 employees. Requires the Secretary to award grants, available until 2015, to States for planning and establishment of American Health Benefit Exchanges. National Prevention, Health Promotion and Public Health Council.