Patient Protection & Affordable Care Act, P.L. 111-148;. Health Care .... Value-Based. Insurance Design. & Cover
Your New Health Care System Patient Protection & Affordable Care Act, P.L. 111-148; Health Care & Education Reconciliation Act, P.L. 111-152
UNDERSTANDING THE OBAMACARE CHART (CHART ORIGINALLY RELEASED JULY 2010)
Prepared by: Joint Economic Committee, Republican Staff Congressman Kevin Brady, Vice Chairman
A high resolution PDF for large chart prints is available at:
http://tinyurl.com/2bd928t
Joint Economic Committee | Republicans
§§1501, 10106; HCERA §§1002, 1004
Your New Health Care System
§3021 §5605
§3403, 10320 §6301 §6301 §8002 §1411 §4002
President
§8002
§8002
§8002
§8002
§8002
§3012
§1411
§1313, 10104
§1313, 10104
§§1322, 10104
§1322, 10104
Private Purchasing Council §1322
Internet Portal §1311
§§1201, 1301,1302, 1311, 1312, 1313, 1321, 1323, 1334, 1411, 1413, 10104; HCERA §1204
Small Business Health Options Program
Data Collection
§1311
§1311
§2602
§1001, 10101
MEWA Health Plans
§1511 §1512
§1311
§§9015, 10906; HCERA §1402
Rationing Potential
Mandates
Involvement in Health Insurance Market
Taxes & Monetary Fees/ Penalties/Cuts Trust Fund (Rationing Potential) Other New Trust Funds/ Monetary Benefits
Government with Expanded Authority/ Responsibility
Mandates, Regulations, & Taxes
Government Financial Entity with New Inflows/ Outflows State/Territory with Expanded Authority/ Responsibility
Regulations/ Requirements/Mandates Reporting Requirements
Unchanged Private Entity
Money Flows Consultation/Advisory/ Info Sharing Structural Connections (Includes Existing)
Special Interest Provisions
Oversight
10% Tax On Indoor Tanning Services:
§1512 §§9017, 10907
§§1311, 1411, 1501, 9003-9005, 9013, 9015, 9017, 10106, 10902, 10906, 10907; HCERA §§1002, 1004, 1402, 1403
§§9017, 10907 §9013
Flexible Spending Arrangement §9005, 10902; HCERA §1403
§§9005, 10902; HCERA §1403
New Relationships
Private Entity with New Mandates/ Regulations/ Responsibilities
§§1421, 10105
Small Business Employees
Individuals
§3311
Private
Small Business Health Insurance Tax Credit
FSA Contribution Limit: $2,500 §§9005, 10902; HCERA§1403
Patients
Only Medical Expenses Above 10% of Income (AGI) are Tax Deductible
§§9010, 10905; HCERA §1406
Medicare Beneficiaries §3311
Expanded Government
§1421, 10105
§§9015, 10906; HCERA §1402
§§1304, 1311, 1421, 1512, 10105
§1512
§9003
§9002
HCERA §1402
Medicare Payroll Tax Increase: 0.9%
Large Business Employees
§§1501, 10106; HCERA §§1002, 1004
Small Employers
§§1511, 1512, 1513, 9001, 9002, 10106, 10901; HCERA §§1003, 1401
§1511, 1512
3.8% Investment Income Tax
§9004
§1511
HSA Use Restriction
§1513, 10106
§1512
Misuse of HSA Funds
Mandates, Regulations, & Taxes
§1501
§3311 §3311
§§1401, 1412, 10105; HCERA §§1001, 1004
§§1513, 10106; HCERA: §1003
§§1201, 1301
§3311
§3004
§§1001, 10101
§3004 §3004 §3004
New Government
§§1514, 10106
§3301; HCERA §1101
Health Insurance Policy Holder
Individual Mandate: Buy Health Insurance
§§9001, 10901; HCERA §1401
§1411
§2701
“Cadillac Plans” Tax
§§1001, 10101
§1301
§§9001, 10901; HCERA §1401
§§9001, 10901; HCERA §1401
§§9003, 9004
§§1001, 10101
Self-Insured Health Plans
Employers
Health Savings Accounts
“Excessive Profits” Premium Tax Credit Subsidies
§§1304, 1511, 1512, 1513, 1514, 10106
HCERA §1402
Subsidy: Medicare Part D Drug Program “Donut Hole”
§3007 §3004 §3004 §3004 §3004 §3004
Medicaid Quality Measurement Program
§§1402, 1412; HCERA §1001
§9002
§1511
§9004
§3004, 3005
§3301; HCERA §1101
§2701
Subsidies: Out-of-Pocket Expenses
W2 Health Insurance Disclosure
§§1513, 10106; HCERA §1003
Large Employers
§§1201, 1301, 1511
§§1001, 1201, 1252, 1301, 1334, 1341, 3311, 9001, 9010, 10101, 10104, 10901, 10905; HCERA §§1401, 1406
§9003
§§3007
Hospital Quality Reporting Program
Medicare Prescription Drug and MA-PD Complaint System
§§3201, 10318; HCERA §1102; CBO Cost Estimate, 3/20/10
§1511
Large Group Market
Mandates, Regulations, Required Benefits, & Taxes
§§1001, 10101
§§3007
§3311
§§9010, 10905; HCERA §1406
§§1401, 1412, 10105; HCERA §§1001, 1004
§§3002, 10327, 10331 §§3002, 10327, 10331
Physician Value-Based Payment Modifier
Title III; CBO Cost Estimate, 3/20/10
Medicare Advantage Cuts: $205.9bn
§2701
StateSpecific Adult Health Quality Measures
(includes MA cuts)
§§3201, 10318; HCERA §1102
Title III, §2602
§2701
§2701
§§3002, 10327, 10331
Hospital Compare Website §3001
Annual Fee
§2701
§3004
Physician Quality Reporting System
Medicare Cuts: $528.9bn
§§9010, 10905; HCERA §1406
§2701
§3004
§3005
§§1311, 3002, 3003, 10327, 10331
Long-Term Care Hospitals
§3005
Inpatient Rehabilitation Facilities
§3005
Physicians
§3005
Medicare
Title III
Medicare Part C & Part D Insurers
§2701
PPS-Exempt Cancer Hospitals
§3004
§§2602, 2701, 2703, 3011
§3022, 10307
§§1201, 1301, 1304
Employer Mandate: Provide Health Insurance
Mandatory Worker AutoEnrollment
§1301, 1304, 1342
Health Insurance Companies
§3311
§2701
Hospice Programs
§3007
§2602
§§3001, 10335
§§3004, 3005
§3311
§§1311
§2703
State Medicaid Agencies
§§2001-2004 CBO Cost Estimate, 3/20/10
§3001
Hospital Value-Based Purchasing Program
Medicare Administrative Contractors
§§1311, 3001-3006, 3311, 9008, 9009, 10327, 10331, 10335, 10904; HCERA §§1404, 1405
Public Data Disclosure System §3006, 10301
§§3022, 10307
§3006
§§3001, 10335
§§3006, 10301
§1511
§§1311, 3001, 10335
§§3001, 10335
§2703
Medicaid Expansion: +16 million
§1342
Hospitals
Mandates, Regulations, Taxes, & Payment Cuts
Demonstration Program §3001
§§3001, 10335
Small Group Market §§1514, 10106
§§1402, 1412; HCERA §1001
Health Industry
§1341, 10104
§§3006, 10301
Title II; §§1413, 3011
§§1301, 6605
§1201, 1301, 1304, 1342
§2703
§§3006, 10301
Medical Device Manufacturers
Medicaid/ CHIP
FFS Accountable Care Organizations Program
17
§1334, 10104
§§3006, 10301
Medicaid Health Home Program
§2602
§§2001-2004
NonHospital Value-Based Purchasing Program
§§3006, 10310
§§1311, 1413
§§3021, 10305, 10306
§§3013, 3021, 3026, 3403, 10305, 10306, 10320
§3021
Individual Market
§6605
§§1201, 1301, 1304
§2703
§§3006, 10301
Skilled Nursing Facilities
CMS
§2602
§2602
§§3022, 10307
§§9009, 10904
§9008; HCERA §1404
§§9009, 10904; HCERA §1405
Ambulatory Surgical Centers
Center for Medicare & Medicaid Innovation
§§1001, 1101, 1201, 1251, 10101, 10103; HCERA §2301
§§1001, 10101
4
§3403
§3026
§2602 §3011
Medical Device Excise Tax
§§1331, 3403, 10104
§3026
5 2 0 3 , 52 0 4 , 5 20 5 , 5311
§3403, 10320
CommunityBased Care Transitions Program
§2703
§§3021, 10305, 10306
§§9015, 10906; HCERA §1402
Loan Repayment & Forgiveness Programs
Federal Coordinated Health Care Office
CMS Actuary
§3026
§3026, 6301
Insurance Mandates
§1342
§3013
§§9001, 10901; HCERA §1401
Risk Corridors
§1342
§1334, 10104
§1513, 10106
Medicare Part B Trust Fund
§§3403, 10320
Health Insurance CO-OP
§1322
§1421, 10105
CO-OP Advisory Board
§§1322, 10104
§§1341, 10104
§1321
§1313, 10104
§1322
§§1501, 10106; HCERA §§1002, 1004
§1313, 8002, 10104
§§9004, 9005; HCERA §1402
§§1341, 10104
§§1341, 10104
§§1311, 10104
§§1311, 10104
§1411
§1411
§3001
§§1401, 10105
§§1311, 10104
§§1331, 10104
§1323; HCERA §1204
§1323; HCERA: §1204
Government Health Benefit Exchanges
§1342
§§3403, 10320
Represents Bundles of Additional Entities
US Territories
§1323; HCERA: §1204
§3026
IPAB Consumer Advisory Council
Other Expansions
§1331, 10104
§1001
Eligibility Determinations
§1411
HHS Inspector General
§1411
§§3403, 10320
§§1341, 10104
§1411
§1561
§4302
Reinsurance Program
§§1301, 10104
Privacy Study
§3026
§3026, 3403, 6301,9015
§§1333, 10104
§§1333, 10104
§§1301, 1302, 1311, 10104
§1301
Health IT Policy Committee
§1561
§§1311, 10104
§1001
§3011
§3013
§1001
Health Care Choice Compacts
NAIC §§1333, 1341, 10104
Qualified Health Plans
§1411
§8002
§§3013, 10304
Value-Based Insurance Design & Coverage of Preventive Health Services
§1001
§4302
§3011
§3403
Medicare Part A Trust Fund
§§9001, 10901; HCERA §1401 §1333, 10104
Gold
§1311
§§3011, 3012
National Health Disparities Data Collection & Reporting System
National Health Strategy & Priorities Office
§§1201, 1301, 1302
§1001
§3011
§3011
§3013
Public Health Quality & Efficiency Measures Development Program
Health Care Quality Website
§10407
States
Platinum
§§1401, 3001, 3403, 6301, 10105, 10320
Vital Statistics Agencies
§6703
§§1311,1331, 1333,1341, 10104, 10407
§1001
Health & Human Services
§3011 §4302
§1331, 10104
§6703
§6703
§1411
§§3011, 4002, 4302
Silver
§1341, 10104
§1331, 10104
§1331, 10104
§4004
§4002
§3011
US Preventive Services Task Force
Secretary
Website “Transparency in Government” §1552
Public Health Service
§4001
§3011
§9008; HCERA §1404
Prevention Website §4004
§3011
Advisory Group on Prevention, Health Promotion, and Integrative and Public Health
§4305
4
§3403, 10320
§9008; HCERA §1404
§6703
§6703
§4305
§6301
§6301
Interagency Pain Research Coordinating Committee
§1001, 10101
Annual Fee
§3012
§§1001,1201, 1301, 1302
Bronze
State Surveyors
§§1201, 1301, 1302
§4001
§4001
§4001
§9008; HCERA §1404
Essential Health Benefits Package
§1311
Surgeon General
§§1331, 10104
§§1311, 10104
§3012, 3013, 6031
22
Optional Basic Health Program
§1302
AHRQ
§10407
§4001
§4305
Prevention & Public Health Fund
1 4 1 2 , 35 0 9 , 5 10 1 , 10104, 10221, 10334, 10413, 10501
GAO §1331, 10104
§6703
§6703
§4001
Rules for Insurance Claims Appeals
Pharmaceutical Companies
26
§4004
§4002
1 1 0 4 , 61 0 2 , 6 10 3
§§9009, 10904; HCERA §1405
§10407
§6301
National Prevention, Health Promotion, & Public Health Council
§4002
Other New Regulatory Programs
§3006
1 2 0 1 , 27 0 4 , 2 70 5 , 2 7 06 , 2707, 3023, 3024, 3113, 3140, 4204, 4206, 5304, 5509, 6112, 6114, 10212, 10221, 10315, 10323, 10326, 10504, 10607
§§1313, 1322
§2602
§2602
Elder Justice Coordinating Council
Elder Abuse, Neglect, & Exploitation Forensic Centers §6703
§10407
§4001
§§1001, 1302, 1311, 1511, 1512, 1513, 6605, 10101, 10106
Home Health Agencies
National Diabetes Mortality Statistics Education Training Program
§§1001, 4003, 4004, 4102, 10407
§1302
§3012
§§9009, 10904; HCERA §1405
§4102
§4004
CDC
§4004
§§4305, 6301, 10409
National Training Institute for Federal and State Surveyors §6703
Comptroller General
MedPAC
§10407
Other New Demonstration & Pilot Programs
§4102
Other New Bureaucracies
§6301
IPAB
Advisory Board on Elder Abuse, Neglect, & Exploitation §6703
§3311
MultiDisciplinary Panels on Improving LongTerm Care §6703
§6703
§3013
Labor Department
§§1513, 10106
National Diabetes Report Card Program §10407
§6703
§6301
§3012
Black Lung Benefits Act
Hours of Service Determination for Calculating Employer Mandate Penalty
§1312
§6301 §6301
PCORI Expert Advisory Panels
§6301
§1556
§5605
§6301
§6703
PCORI Trust Fund
§3012
NIH
§10409
§6301
§6703
Interagency Working Group on Health Care Quality
National Partnership on Prevention & Health Promotion
§4004
§1334, 10104
Justice Department
§10409
§10409
PCORI Methodology Committee
§§6301, 10602
§4004
PCORI
§1334, 10104
§4004
§3012
Cures Acceleration Network
§6301
§1312
§§1331, 10104
§4004
§6301
19
1 1 0 2 , 1 20 1, 2 0 0 6,3 1 3 7 , 3 20 1 , 3 3 0 1 , 6 0 0 1 , 9 0 0 1 , 9 0 1 0 , 9 0 14 , 9 0 2 3 , 1 0 2 0 1 , 1 0 3 1 7 , 1 0 3 2 3, 1 0 3 2 4, 1 0 5 0 2 , 1 0 6 0 1 , 1 09 0 1 , 1 0 90 5 ; HCERA 1 1 0 1 , 1 10 3 , 1106, 1203, 1406
§1333, 10104
National Oral Health Public Education Campaign
§4003 §4003
§6301
National Public Education Campaign on Prevention & Health Promotion
§5605
Congress §§1312, 1411, 3311, 5605, 8002
§§1331, 10104
§8002
Community Preventive Services Task Force
BENEFICIARIES: Mut ual of Omaha (NE); Drug Cos; NJ Drug Cos; AARP; Libby Mont anans; Physician-Owned Hospit als; Univ. of CT; Medigap Plans; Longshoreman Healt h Plans; Medicaid: HI, LA, MA, TN, VT; Medicare: CT, FL, MI, MT, ND
§8002
§6703
§8002
PCORI Board of Governors Office of Multi-State Qualified Health Plans
§6301
§6301
CLASS Independence Benefit Plan
Special Interest Provisions
§5605
Office of Tax Analysis
§8002
Cures Acceleration Network Review Board §10409
PCORI Website
§§1513, 10106; HCERA §1003
§§1401, 1402, 1411, 1412 1414, 1421, 1501, 9004, 9005, 10105, 10901; HCERA §§1401, 1402
§§1311, 1331, 4002, 8002, 10104
§8002
§8002
§6301
Personal Care Attendants Workforce Advisory Panel §8002
§5605
Congress Members & Personal Staff Mandate: Only Exchange Coverage
§9002
CLASS Independence Fund Board of Trustees
§8002
Treasury Department
Commission on Key Indicators
Key National Indicator System Implementation Institute
§§3103, 10320
§3403, 10320
CLASS Program
§8002
§1411 §8002
10323, 10333, 1 0 4 0 8 -1 0 , 1 0 4 1 3 , 10501, 10503
§8002 §8002
§8002
Office of Personnel Management
§8002
§8002
Social Security Administration
59
1 0 0 2 , 10 0 3 , 1 31 1 , 1 3 22 , 1 5 6 1 , 2 9 5 2 , 2 9 5 3 , 3 5 0 1 -6 , 3508, 4101, 4108, 4201, 4202, 4304, 5102 , 5206, 5 2 0 8 , 5 3 0 1 -5 3 0 3 , 5 3 0 5 , 5306, 5309 , 5313, 5 3 1 5 , 5 4 0 5 , 5 5 0 7 -8 , 5604, 6703, 10301
§8002
CLASS Independence Fund
§3403, 10320
State Protection & Advocacy Systems
IRS
Other New Grant Programs
§5605
§§ 3012, 3024, 3403, 4001, 8002, 10320
Eligibility Assessment System
CLASS Independence Advisory Council
Life Independence Accounts
§1411
§§1334, 10104
National Academy of Sciences
§1414 §1411
§1312
Homeland Security Department
§5605
§5605 §5605
§8002
§9013
§§1401, 1412, 10105; HCERA §§1001, 1004
AGI: Adjusted Gross Income AHRQ: Agency for Healthcare Research and Quality CDC: Centers for Disease Control & Prevention CHIP: Children’s Health Insurance Program CLASS: Community Living Assistance Services & Supports CMS: Centers for Medicare & Medicaid Services CO-OP: Consumer Operated & Oriented Program FFS: Fee-for-Service FSA: Flexible Spending Arrangement GAO: Government Accountability Office HCERA: Health Care & Education Reconciliation Act HHS: Health & Human Services Department
HSA: Health Savings Account IPAB: Independent Payment Advisory Board IRS: Internal Revenue Service MA-PD: Medicare Advantage Prescription Drug MedPAC: Medicare Payment Advisory Commission MERD: Medical Early Risk Detection EALORS: Executive Auxiliary Linked Office Regional Systems MEWA: Multiple Employer Welfare Arrangement NAIC: National Association of Insurance Commissioners NIH: National Institutes of Health PCORI: Patient-Centered Outcomes Research Institute PPS: Prospective Payment System
§§1402, 1412; HCERA §1001
Patient Protection & Affordable Care Act, P.L. 111-148; Health Care & Education Reconciliation Act, P.L. 111-152
Prepared by: Joint Economic Committee, Republican Staff Congressman Kevin Brady, Senior House Republican Senator Sam Brownback, Ranking Member
Your New Health Care System
CHART MAP
Patient Protection & Affordable Care Act, P.L. 111-148; Health Care & Education Reconciliation Act, P.L. 111-152
·
Government take-over of 1/6th of the U.S. Economy
·
Everything in COLOR is newly added by the bill --Except for the HHS Secretary, who has been given new sweeping powers over health care
·
Chart only shows 1/3rd of all the new and expanded bureaucracies, regulations, and programs (see bundles for additions that could not fit on chart)
·
The new law will cost $2.6 trillion in the first 10 years of full implementation
ORANGE: Opportunity for government to ration care: --PCORI --IPAB --“Value-Based”
DARK BLUE: Expansion of government
LIGHT BLUE: New government involvement in private health insurance markets (Up to 117 million will lose their current coverage, according to HHS)
TRI-COLOR SHAPES: Bundles of ADDITIONAL entities +19 Special Interest Provisions +59 Grant Programs +26 Demo & Pilot Programs +22 Bureaucracies +4 Regulatory Programs +4 Loan Programs
YELLOW: Specific Mandates
RED LINES: new regulations/mandates/ requirements BLACK LINES: new reporting requirements BLUE LINES: new oversight authority GREEN LINES: new money flows YELLOW LINES: new consultation/advisory/ information sharing GRAY LINES: structural connections, including existing connections
OUTLINES: Everything with an outline has been changed by the bill (Only 1 shape without an outline: Self-Insured Employer Health Plans)
GREEN: Taxes, Fees, Penalties ($569bn), and Medicare cuts ($520bn, including $206bn from Medicare Advantage)
Health Care Providers
Physicians
CMS and Dr. Donald Berwick: “Rationer-in-Chief”
159 Bureaucracies, Programs, and Regulatory Systems
Patients
Your New Health Care System
SUMMARY EXPLANATION GENERAL Everything in COLOR is newly added by the bill, except for the HHS Secretary, who has been given new sweeping powers over health care Everything in WHITE (cream) existed previously Everything in WHITE with an OUTLINE has been expanded or changed -
RED OUTLINES on white shapes are expanded government
-
GREEN OUTLINES on white shapes are financial government entities
-
BLUE OUTLINES on white shapes are changed private entities
-
NO OUTLINE on a white shape is an unchanged entity (there is only one) COLORED SHAPES: ALL NEW GOVERNMENT
ORANGE CIRCLES indicate new potential for the government to ration care LIGHT BLUE CIRCLES are new government involvement in the health insurance market GREEN DIAMONDS are taxes, fees, penalties, and cuts YELLOW HEXAGONS are specific mandates DARK BLUE CIRCLES are other expansions of government DARK BLUE DIAMONDS are new government trust funds or monetary benefits, including subsidies and health insurance related tax credits TRI-COLOR SHAPES (Dark Blue, Green, & Red) are bundles representing a number of additional entities LINES: NEW RELATIONSHIPS RED LINES are for new regulations, mandates, and requirements BLACK LINES are for new reporting requirements BLUE LINES are for new oversight authority GREEN LINES are for new money flows YELLOW LINES are for new consultation, advisory, and/or information sharing relationships GRAY LINES indicate structural connections, including existing connections
CHART ADDENDUM Bundle: Special Interest Provisions
1.
§ 1102
$5 billion for labor union health plans.
2.
§ 1201
Exemption for AARP from ban on preexisting condition exclusions.
Special Interest Provisions BENEFICIARIES: Mut ual of Omaha (NE); Drug Cos; NJ Drug Cos; AARP; Libby Mont anans; Physician-Owned Hospit als; Univ. of CT; Medigap Plans; Longshoreman Healt h Plans; Medicaid: HI, LA, MA, TN, VT; Medicare: CT, FL, MI, MT, ND
19
1 1 0 2 , 1 20 1, 2 0 0 6,3 1 3 7 , 3 20 1 , 3 3 0 1 , 6 0 0 1 , 9 0 0 1 , 9 0 1 0 , 9 0 14 , 9 0 2 3 , 1 0 2 0 1 , 1 0 3 1 7 , 1 0 3 2 3, 1 0 3 2 4, 1 0 5 0 2 , 1 0 6 0 1 , 1 09 0 1 , 1 0 90 5 ; HCERA 1 1 0 1 , 1 10 3 , 1106, 1203, 1406
3.
§ 2006
$300 million for the Louisiana Medicaid program.
4.
§ 3137
Special higher Medicare payments for Michigan and Connecticut.
5.
§ 3201
Special treatment for Florida Medicare Advantage Plans.
6.
§ 3301
Billions for brand-name drug companies under the Part D drug program.
7.
§ 6001
Special treatment for certain physician-owned hospitals.
8.
§ 9001
Special tax exemption for Longshoreman health plans.
9.
§ 9010
Special tax exemption for BCBS of Michigan, BCBS of Nebraska, & AARP.
10.
§ 9010
Special exemption for AARP, Mutual of Omaha, etc., medigap plans.
11.
§ 9014
Exemption for AARP from $500k cap on insurance executives’ compensation.
12.
§ 9023
$1 billion for New Jersey based pharmaceutical companies.
13.
§ 10201
Extra Medicaid DSH funds for Hawaii hospitals.
14.
§ 10201
$1.1 billion for the Vermont and Massachusetts Medicaid programs.
15.
§ 10323
Special Medicare eligibility for coal miners in Libby, Montana.
16.
§ 10324
Higher Medicare reimbursements for “frontier states” (e.g., MT, ND).
17.
§ 10502
$100 million for the Univ. of Connecticut Health Center.
18.
§ 1103 Exemption for AARP from health insurer overhead spending cap. (HCERA)
19.
§ 1203 $100 million for Tennessee hospitals. (HCERA) Your New Health Care System
CHART ADDENDUM
Insurance Mandates
Bundle: Insurance Mandates 1.
§ 1001, Must cover adult dependent children §1251, to age 26 §2301(HCERA)
2.
§ 1001
Must provide unlimited lifetime and annual payouts
3.
§ 1001
Must provide access to preventive benefits, as prescribed by HHS Secretary, without cost-sharing
4.
§ 1001, §10101
Must provide uniform explanation of coverage documents with standardized definitions
5.
§ 1001, §10101
Must follow federal rules for enrollee claims appeals and provide notices in a “culturally and linguistically appropriate manner”
6.
§ 1001, §10101
Must provide unlimited beneficiary access to providers within network
7.
§ 1001, §10101
Must provide unlimited beneficiary access to emergency rooms without additional cost-sharing
8.
§ 1001, §10101
Must provide unlimited beneficiary access to OB-GYNs without prior authorization
9.
§ 1001, §10101
Must not spend more than Government permits on administrative costs
10.
§ 1001
Must not rescind coverage
11.
§ 1101
Must not exclude preexisting conditions
12.
§ 1201
Must not base premiums on health status of beneficiary
13.
§ 1201, §10103
Must not vary premiums based on age more than Government permits
14.
§ 1201
Must cover all applicants regardless of health status
15.
§ 1201
Must renew coverage
16.
§ 1201
Must provide comprehensive coverage as defined by HHS Secretary
17.
§ 1201, §10103
Must provide access to all covered benefits no later than 90 days after enrollment
§§1001, 1101, 1201, 1251, 10101, 10103; HCERA §2301
17
Your New Health Care System
CHART ADDENDUM Bundle: Grant Programs 1. 2.
§ 1002 § 1003
3. 4.
§ 1311 § 1311
5. 6.
§ 1322 § 1561
7.
§ 2952
8.
§ 2953
9.
§ 3501
10.
§ 3502
11.
§ 3503
12.
§ 3504
13.
§ 3505
14.
§ 3506
15.
§ 3506
16.
§ 3508
17.
§ 4101
18.
§ 4108
19. 20.
§ 4201 § 4202
21.
§ 4304
22.
§ 5102
23.
§ 5102
24.
§ 5206
25.
§ 5208
26.
§ 5301
27.
§ 5302
28.
§ 5303
29.
§ 5305
30.
§ 5305
31.
§ 5306
32.
§ 5309
Grant program for consumer assistance offices Grant program for states to monitor premium increases Grant program to establish state Exchanges Exchange grants to establish consumer navigator programs Grant program for state cooperatives Grant program to implement health IT enrollment standards Grant program for delivery of services to individuals with postpartum depression State allotments for grants to promote personal responsibility education programs Grant program for technical assistance to providers implementing health quality practices Grant program to establish interdisciplinary health teams Grant program to implement medication therapy management Grant program to support emergency care pilot programs Grant program to promote universal access to trauma services Grant program to develop and promote shared decision-making aids Grant program to support implementation of shared decision-making Grant program to integrate quality improvement in clinical education Grant program to support school-based health centers Grant program for States to prevent chronic disease in Medicaid beneficiaries Community transformation grants Grant program to provide public health interventions Grant program to increase epidemiology and laboratory capacity Grant program to plan health care workforce development activities Grant program to implement health care workforce development activities Grant program for mid-career training for health professionals Grant program to fund nurse-managed health clinics Grant program to support primary care training programs Grant program to fund training for direct care workers Grant program to develop dental training programs Grant program to promote geriatric education centers Grant program to promote health professionals entering geriatrics Grant program to promote training in mental and behavioral health Grant program to promote nurse retention programs
Other New Grant Programs 33. § 5313
34. § 5315 35. § 5405 36. § 5507 37. § 5507 38. § 5508 39. § 5508 40. § 5604 41. § 6703 42. § 6703 43. § 6703 44. § 6703 45. § 6703 46. § 6703 47. § 6703 48. § 10301 49. § 10323 50. § 10333 51. § 10408 52. § 10409 53. § 10410 54. § 10413 55. § 10501 56. § 10501 57. § 10501 58. § 10501 59. § 10503
Grant 1 0 0 2 , 10 0 3 , 1 31 1 , 1 3 22 , program 1 5 6 1 , 2 9 5 2 , 2 9 5 3 , 3 5 0 1 -6 , 3508, 4101, 4108, 4201, to promote 4202, 4304, 5102 , 5206, positive health 5 2 0 8 , 5 3 0 1 -5 3 0 3 , 5 3 0 5 , 10323, 10333, 5306, 5309 , 5313, 1 0 4 0 8 -1 0 , 1 0 4 1 3 , behaviors and 5 3 1 5 , 5 4 0 5 , 5 5 0 7 -8 , 10501, 10503 5604, 6703, outcomes 10301 Public Health Sciences Track for medical students Primary Care Extension Program to educate providers Grant program for demonstration projects to address health workforce shortage needs Grant program for demonstration projects to develop training programs for home health aides Grant program to establish primary care residency programs Program of payments to teaching health centers that sponsor medical residency training Grant program to establish demonstration projects for community-based mental health settings Grant program to promote continuing education for long-term care staffers Grant program to improve management practices and training Grant program to subsidize costs of electronic health records Grant program to promote adult protective services Grant program to conduct elder abuse detection and prevention Grant program to support long-term care ombudsmen Grant program to fund State surveys of long-term care residences Value-based purchasing program for ambulatory surgical centers Grant program to screen at-risk individuals for environmental health conditions Grant program to support community based collaborative care networks Grant program to promote small business wellness programs Grant program for Cures Acceleration Network Grant program to promote centers of excellence for depression Grant program to provide assistance to provide information to young women with breast cancer Grant program to train nurse practitioners as primary care providers Grant program for community-based diabetes prevention Grant program for providers who treat a high percentage of medically underserved populations Grant program to recruit students to practice in underserved communities Community Health Center Fund
59
Your New Health Care System
CHART ADDENDUM Bundle: Demonstration & Pilot Programs Demonstration program for state wellness programs Medicaid demonstration project to evaluate bundled payments Medicaid demonstration project for global payment system Medicaid demonstration project for accountable care organizations
Other New Demonstration & Pilot Programs
1.
§ 1201
2.
§ 2704
3.
§ 2705
4.
§ 2706
5.
§ 2707
Medicaid demonstration project for emergency psychiatric care
6.
§ 3023
Medicare pilot program on payment bundling
7.
§ 3024
Independence at home medical practice demonstration program
8.
§ 3113
Demonstration project for payment of complex diagnostic laboratory tests
9.
§ 3140
Medicare hospice concurrent care demonstration project
10.
§ 4204
Demonstration program of grants to improve child immunization rates
11.
§ 4206
Pilot program for risk-factor assessments provided through community health centers
12.
§ 5304
Demonstration program to increase access to dental health care in underserved communities
13.
§ 5509
Graduate nurse education demonstration program
14.
§ 6112
National independent monitor pilot program for skilled nursing facilities and nursing facilities
15.
§ 6114
Demonstration projects for nursing facilities involved in the culture change movement
16.
§ 10212 Pregnancy Assistance Fund
17.
§ 10315 Demonstration project for payment adjustments to home health services
18.
§ 10323 Pilot program for care of individuals in environmental emergency declaration areas
19.
§ 10326 Pilot programs to implement value-based purchasing
20.
§ 10504 Demonstration project to provide access to health care for the uninsured at reduced fees
21.
§ 10607 Demonstration program to explore alternatives to tort litigation
22.
§ 10221 Indian Health demonstration program for chronic shortages of health professionals
23.
§ 10221 Indian Country modular component facilities demonstration program
24.
§ 10221 Indian mobile health stations demonstration program
25.
§ 10221 Indian youth telemental health demonstration project
26.
§ 10221 Indian youth life skills demonstration project
1 2 0 1 , 27 0 4 , 2 70 5 , 2 7 06 , 2707, 3023, 3024, 3113, 3140, 4204, 4206, 5304, 5509, 6112, 6114, 10212, 10221, 10315, 10323, 10326, 10504, 10607
26
Your New Health Care System
CHART ADDENDUM Bundle: Bureaucracies
Other New Bureaucracies 1 4 1 2 , 35 0 9 , 5 10 1 , 10104, 10221, 10334, 10413, 10501
22
1.
§ 1412
Program for advance determination of tax credit eligibility
2.
§ 3509
3.
§ 3509
Health and Human Services Coordinating Committee on Women’s Health Centers for Disease Control Office of Women’s Health
4.
§ 3509
Agency for Healthcare Research and Quality Office of Women’s Health
5.
§ 3509
Health Resources and Services Administration Office of Women’s Health
6.
§ 3509
Food and Drug Administration Office of Women’s Health
7.
§ 5101
National Health Care Workforce Commission
8.
§ 10104
Advisory board for multi-state health plans
9.
§ 10334
Centers for Disease Control Office of Minority Health
10. § 10334
Health Resources and Services Administration Office of Minority Health
11. § 10334
Substance Abuse and Mental Health Services Administration Office of Minority Health
12. § 10334
Agency for Healthcare Research and Quality Office of Minority Health
13. § 10334
Food and Drug Administration Office of Minority Health
14. § 10334
Centers for Medicare and Medicaid Services Office of Minority Health
15. § 10413
Advisory committee for young women’s breast health awareness education campaign
16. § 10501
Interagency Access to Health Care in Alaska Task Force
17. § 10221
Office of Indian Men’s Health
18. § 10222
Office of Direct Service Tribes
19. § 10223
Indian Health Service mental health technician training program
20. § 10224
Indian Health Service program for treatment of child sexual abuse victims
21. § 10225
Indian Health Service program for treatment of domestic violence and sexual abuse
22. § 10226
Indian Health Service Director of HIV/AIDS Prevention and Treatment Your New Health Care System
CHART ADDENDUM Bundle: Regulatory Programs
Other New Regulatory Programs 1 1 0 4 , 61 0 2 , 6 10 3
4
1.
§ 1104
Committee to review administrative simplification standards
2.
§ 6102
Quality assurance and performance improvement program for skilled nursing facilities
3.
§ 6103
Special focus facility program for skilled nursing facilities
4.
§ 6103
Special focus facility program for nursing facilities
Your New Health Care System
CHART ADDENDUM
Loan Repayment & Forgiveness Programs
Bundle: Loan Repayment & Forgiveness Programs
5 2 0 3 , 52 0 4 , 5 20 5 , 5311
1.
§ 5203
Pediatric specialty loan repayment program
2.
§ 5204
Public Health Workforce Loan Repayment Program
3.
§ 5205
Allied Health Loan Forgiveness Program
4.
§ 5311
Student loan forgiveness for nursing school faculty
4
Your New Health Care System
CHART ADDENDUM
Judicial Review Limitations
Bundle: Judicial Review Limitations (Not Appearing as Bundle on Chart)
3 0 0 1 , 30 0 3 , 3 00 7 , 3 0 08 , 3021, 3022, 3025, 3133, 3403, 5501, 5508, 6001, 6401, 10409
14
1.
§ 3001
Hospital Value Based Purchasing Program
2.
§ 3003
Physician Feedback Program
3.
§ 3007
Physician Value Based Purchasing Program
4.
§ 3008
Hospital Acquired Conditions
5.
§ 3021
Centers for Medicare and Medicaid Innovation
6.
§ 3022
Medicare Shared Savings Program (Accountable Care Organizations)
7.
§ 3025
Hospital Readmission Reduction
8.
§ 3133
Medicare DSH Program
9.
§ 3403
Independent Payment Advisory Board (IPAB)
10. § 5501
Expanded Access to Primary Care Services
11. § 5508
Teaching Health Centers Training and Enhancement
12. § 6001
Physician Owned Hospitals
13. § 6401
Provider Screening
14. § 10409
Cures Action Network
Your New Health Care System
