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Below is a helpful timeline that shows what legislative changes are coming based on PPACA Health Refrom from the Obama Administration.

This is part of a 7 part series called Navigating Health Reform, please review some of our past entries.

Part 1: http://www.ohioindividualhealthinsurance.net/?p=422
Part 2: http://www.ohioindividualhealthinsurance.net/?p=432
Part 3: http://www.ohioindividualhealthinsurance.net/?p=437
Part 4: http://www.ohioindividualhealthinsurance.net/?p=444
Part 5: http://www.ohioindividualhealthinsurance.net/?p=510&preview=true&preview_id=510&preview_nonce=c647e96663
2010:

Reduces annual market basket updates for inpatient and outpatient hospital services, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals and units and adjusts payments for productivity.

Implementation: Beginning fiscal year 2010; productivity adjustments added to market basket update in 2012

Implementation update: The Centers for Medicare and Medicaid Services has issued several proposed and final rules reducing annual market basket updates for different provider types: inpatient hospital services (Final Rule August 16, 2010; Proposed Rule for FY 2012 issued April 20, 2011), outpatient hospital services (Final Rule November 3, 2010), long-term care hospitals (Final Rule August 16, 2010; Proposed Rule for FY 2012 issued April 20, 2011), inpatient rehabilitation facilities and psychiatric hospitals and units (Proposed Rule January 27, 2011).

2010:

Provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010.

Further subsidies and discounts that ultimately close the coverage gap begin in 2011.

2010:

Increases 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%) and to 13% of average manufacturer price for non-innovator, multiple source drugs. Extends the drug rebate to Medicaid
managed care plans.

Implementation: January 1, 2010 for increase in Medicaid drug rebate percentage; March 23, 2010 for extension of drug rebate to Medicaid managed care plans Implementation update: The Centers for Medicare and Medicaid Services issued a State Medicaid Directors Letter on April 22, 2010 explaining the new rules.
On August 11, 2010 and September 28, 2010, CMS issued letters to state Medicaid directors with additional guidance on the prescription drug rebates. On January 6, 2011, CMS issued another letter with further changes pursuant to the ACA.

2010:

Establishes the Federal Coordinated Health Care Office to improve care coordination for dual eligibles (people eligible for both Medicare and Medicaid).

Implementation: March 1, 2010

Implementation update: The Federal Coordinated Health Care Office was created in September 2010. On December 30, 2010, CMS issued a notice in the Federal Register announcing the establishment of the Federal Coordinated Health Care Office.

Implementation: January 1, 2010.

Implementation update: In May 2010, CMS issued a consumer brochure with information about the Medicare Part D coverage gap. In June 2010, the first rebate checks were sent to Medicare beneficiaries who reached the Medicare Part D coverage gap, more commonly known as the “doughnut hole.”
As of March 22, 2011, 3.8 million beneficiaries had received a $250 check to close the coverage gap, according to an HHS report.

2011:

Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.

Implementation: January 1, 2011

Implementation update: On December 17, 2010, CMS sent a letter to pharmaceutical companies providing operational guidance for pharmaceutical manufacturers participating in the Medicare Coverage Gap Discount Program. According to the guidance, the Discount Program became effective
January 1, 2011. On June 28, 2011, CMS announced that nearly 500,000 people had received a discount on their brand-name prescription drugs, with an average savings of $545 per beneficiary.
As of August 4, 2011, 900,000 Medicare beneficiaries who hit the prescription drug doughnut hole received a 50 percent discount on their prescription drugs.

2011:

Provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.

Implementation: January 1, 2011 through December 31, 2015

Implementation update: On November 29, 2010, CMS published a final rule that implements the 10 percent incentive payment for primary care services.

2011:

Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive
health risk assessment.

Implementation: January 1, 2011

Implementation update: On November 29, 2010, CMS published a final rule that will augment the benefits for the “Initial Preventive Physical Examination,” an annual visit for the purposes of developing a prevention plan for the patient. On December 2010, CMS released a Medicare Consumer Guide to
Preventative Services, including services that will no longer require cost-sharing (co-pays) in 2011 as a result of the health reform law. As of October 6, 2011, CMS reported that 20.5 million people had participated in the free Annual Wellness Visit or received other preventive services with no cost-sharing.

2011:

Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality.

Implementation: Center established by January 1, 2011

Implementation update: On November 17, 2010, CMS issued a notice announcing the establishment of the Center for Medicare and Medicaid Innovation in its organization.

2011:

Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Implementation: January 1, 2011

Implementation update: On November 4, 2010, CMS issued a fact sheet with Medicare premium information for 2011 reflecting higher premiums for Medicare beneficiaries whose incomes exceed a set threshold.
In January 2011, the Social Security Administration released a consumer publication reflecting the changes.

2011:

Restructures payments to private Medicare Advantage plans by phasing-in payments set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare
Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.

Implementation: January 1, 2011

Implementation update: The Centers for Medicare and Medicaid Services issued a letter to Medicare Advantage plans on April 5, 2010 announcing the freeze in 2011 payment rates at 2010 levels. On November 22, 2010, CMS issued a proposed rule updating the Medicare Advantage program. On April 15, 2011, CMS issued a final
rule updating the Medicare Advantage program.

2011:

Establishes an Independent Advisory Board, comprised of 15 members, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds targeted growth rates.

Implementation: Funding available October 1, 2011; first recommendations due January 15, 2014

2012:

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

Implementation update: On April 7, 2011, the Department of Health and Human Services published a proposed rule in the Federal Register defining Accountable Care Organizations and set out requirements for governance,
legal structure, transparency efforts and the incorporation of evidence-based medicine and quality efforts.

HHS also released facts sheets for providers and consumers, as well as fact sheets on legal issues and quality scoring in ACOs. The Federal Trade Commission and Department of Justice issued a joint policy statement on antitrust issues related to ACOs. On May 20, 2011, CMS issued a request for applications for the Pioneer ACO
Program, which is targeted at organizations that can demonstrate the improvements in quality and cost-savings
of a mature ACO.

2012:
Reduces rebates paid to Medicare Advantage plans and provides bonus payments to high–quality plans.

Implementation: January 1, 2012.

Implementation update: On February 28, 2011, the Centers for Medicare and Medicaid Services issued a letter to Medicare Advantage plans announcing payment rates for 2012 that included changes included in the health reform law.
On November 22, 2010, CMS announced a proposed rule updating Medicare Advantage plan payments.

2012:
Creates the Independence at Home demonstration program to provide high-need Medicare beneficiaries with primary care services in their home.

Implementation: January 1, 2012

2012:
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

2012:
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.

Implementation update: On January 13, 2011, the Centers for Medicare and Medicaid Services issued a proposed rule that would implement a value-based purchasing program for hospitals in Medicare. On May 6, 2011, CMS published a final rule on the value-based purchasing program.

2012:
Reduces Medicare payments that would otherwise be made to hospitals to account for excess (preventable) hospital readmissions.

Implementation: October 1, 2012

2013:
Begins phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

Implementation: January 1, 2013
2013:
Establishes a national Medicare pilot program to develop and evaluate making bundled payments for acute, inpatient hospital physician services, outpatient hospital services, and post-acute care services for an episode of care.

Implementation: January 1, 2013

2013:
Increases Medicaid payments for primary care services provided by primary care doctors to 100% of the Medicare payment rate for 2013 and 2014 (financed with 100% federal funding).

Implementation: January 1, 2013 through December 31. 2014

2013:
Increases the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and imposes a 3.8% assessment on unearned income for higher-income taxpayers.

Implementation: January 1, 2013

2014:
Requires Medicare Advantage plans to have medical loss ratios no lower than 85%.

Implementation: January 1, 2014
2014:
Establishes an Independent Advisory Board, comprised of 15 members, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate.

Implementation: First recommendations due January 15, 2014 (Funding available October 1, 2011)

2014:
Reduces Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increases payments based on the percent of the population uninsured and the amount of uncompensated care provided.

Implementation: October 1, 2014

2014:
Reduces Medicare payments to certain hospitals for hospital-acquired conditions by 1%.

Implementation: Fiscal Year 2015

NOTE: 2011 Annual Election Period (AEP) ends early this year, on December 7, 2011.

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