The Basics

• Approach
• Individual Mandate
• Employer Requirements
• Expansion of Public Programs
• Premium & Cost-Sharing subsidies to Individuals
• Insurance & Finance Health Reform
• Health Insurance Exchanges
• Benefit Design
• Changes to Private Insurance
• State Role
• Health System Performance
• Prevention Wellness
• Long Term Care
• Other Investments

Comparative Effectiveness Research

Comparative effectiveness research will be supported by establishing a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research that compares the clinical effectiveness of medical treatments.

The Institute will be overseen by an appointed multi-stakeholder Board of Governors and will be assisted by expert advisory panels.

Findings from comparative effectiveness research may not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment or used to deny coverage. (Funding available beginning fiscal year 2010) Terminate the Federal Coordinating Council for Comparative Effectiveness Research that was founded under the American Recovery and Reinvestment Act will be terminated. (Effective upon enactment)

 

Medical Malpractice

Five-year demonstration grants will be awarded to states to develop, implement, and evaluate alternatives
to current tort litigations. Preference will be given to states that have developed alternatives in consultation with relevant stakeholders and that have proposals that are likely to enhance patient safety by reducing medical errors and adverse events and are likely to improve access to liability insurance. (Funding appropriated for five years beginning in fiscal year 2011)

 

Medicare

• A national Medicare pilot program will be established to develop and evaluate paying a bundled payment for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care that begins three days prior to a hospitalization and spans 30 days following discharge. If the pilot program achieves stated goals of improving or not reducing quality and reducing spending, develop a plan for expanding the pilot program. (Establish pilot program by January 1, 2013; expand program, if appropriate, by January 1, 2016)
  
• The Independence at Home demonstration program will be created to provide high-need Medicare beneficiaries with primary care services in their home and allow participating teams of health professionals to share in any savings if they reduce preventable hospitalizations, prevent hospital readmissions, improve health outcomes, improve the efficiency of care, reduce the cost of health care services, and achieve patient satisfaction. (Effective January 1, 2012)
  
• A hospital value-based purchasing program will be established in Medicare to pay hospitals based on
  performance on quality measures and extend the Medicare physician quality reporting initiative beyond
  2010. (Effective October 1, 2012) Plans to implement value-based purchasing programs for
  skilled nursing facilities, home health agencies, and ambulatory surgical centers is being developed. (Reports to Congress due January 1, 2011)

 

Dual Eligibles

Care coordination for dual eligibles will be improved by creating a new office within the Centers for Medicare and Medicaid services, the Federal Coordinated Health Care Office, to more effectively integrate Medicare and Medicaid benefits and improve coordination between the federal government and states in order to
improve access to and quality of care and services for dual eligibles. (Effective March 1, 2010)

 

Medicaid

• A new Medicaid state plan option is being created to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home. States taking up the option will be provided with 90% FMAP for two years for home health-related services, including care management, care coordination, and health promotion. (Effective January 1, 2011)
  
• New demonstration projects in Medicaid are being created to pay bundled payments for episodes of care that include hospitalizations (effective January 1, 2012 through December 31, 2016); to make global capitated payments to safety net hospital systems (effective fiscal years 2010 through 2012); to allow pediatric medical providers organized as accountable care organizations to share in cost-savings (effective January 1, 2012 through December 31, 2016); and to provide Medicaid payments to institutions of mental disease for adult enrollees who require stabilization of an emergency condition (effective October 1, 2011 through December 31, 2015).
  
• The role of the Medicaid and CHIP Payment and Access Commission is expanded to include assessments of adult services (including those dually eligible for Medicare and Medicaid). ($11 million in additional funds appropriated for fiscal year 2010)

 

Primary Care

• Medicaid payments in fee-for-service and managed care for primary care services provided by
  primary care doctors (family medicine, general internal medicine or pediatric medicine) increase to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100% federal financing for the increased payment rates. (Effective January 1, 2013)
  
• A 10% bonus payment to primary care physicians in Medicare from 2011 through 2015 is provided. . (Effective for five years beginning January 1, 2011)

 

National Quality Strategy

• Develop a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health. Create processes for the development of quality measures involving input from multiple stakeholders and for selecting quality measures to be used in reporting to and payment under federal health programs. (National strategy due to Congress by January 1, 2011)
  
• Establish the Community-based Collaborative Care Network Program to support consortiums of
  health care providers to coordinate and integrate health care services, for low-income uninsured and
  underinsured populations. (Funds appropriated for five years beginning in FY 2011)

 

Financial Disclosure

Disclosure of financial relationships between health entities, including physicians, hospitals,
pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals,
and medical supplies is required. (Report due to Congress April 1, 2013)

 

Disparities

Enhanced collection and reporting of data on race, ethnicity, sex, primary language, disability
status, and for underserved rural and frontier populations is required. In addition, collection of access and treatment data for people with disabilities is required. The Secretary is requiredto analyze the data to monitor trends in disparities. (Effective two years following enactment)

 

 

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