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

National Strategy

• The National Prevention, Health Promotion and Public Health Council will be established to coordinate federal prevention, wellness, and public health activities. A national strategy is being developedto improve the nation’s health. (Strategy due one year following enactment) A Prevention and Public Health Fund will be established to expand and sustain funding for prevention and public health programs. (Initial appropriation in fiscal year 2010) Task forces on Preventive Services and Community Preventive Services are to be created to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services. (Effective upon enactment)

• A Prevention and Public Health Fund has been established for prevention, wellness, and public health activities including prevention research and health screenings, the Education and Outreach Campaign for
  preventive benefits, and immunization programs. Appropriate $7 billion in funding for fiscal years 2010
  through 2015 and $2 billion for each fiscal year after 2015. (Effective fiscal year 2010)
  
• A grant program has been established to support the delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas. (Funds appropriated for five years beginning in FY 2010)

 

Coverage of Preventive Services

Cost-sharing is eliminated for Medicare covered preventive services that are recommended (rated A or
B) by the U.S. Preventive Services Task Force and waive the Medicare deductible for colorectal cancer
screening tests. The Secretary is authorized to modify or eliminate Medicare coverage of preventive services,
based on recommendations of the U.S. Preventive Services Task Force. (Effective January 1, 2011)

 

• States that offer Medicaid coverage of and remove cost-sharing for preventive services
  recommended (rated A or B) by the U.S. Preventive Services Task Force and recommended
  immunizations are provided with a one percentage point increase in the federal medical assistance percentage (FMAP) for these services. (Effective January 1, 2013)
  
• Medicare coverage of personalized prevention plan services, including a comprehensive
  health risk assessment, is provided annually. The Secretary is required to publish guidelines for the health risk assessment no later than March 23, 2011, and a health risk assessment model by no later than
  September 29, 2011. Providers are reimbursed 100% of the physician fee schedule amount with no
  adjustment for deductible or coinsurance for personalized prevention plan services when these services
  are provided in an outpatient setting. (Effective January 1, 2011)
  
• Incentives are provided to Medicare and Medicaid beneficiaries to complete behavior modification programs. (Effective January 1, 2011 or when program criteria is developed, whichever is first) Medicaid is required to provide coverage for tobacco cessation services for pregnant women. (Effective October 1, 2010)
  
• Qualified health plans are required to provide at a minimum coverage without cost-sharing for preventive
  services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations,
  preventive care for infants, children, and adolescents, and additional preventive care and screenings for
  women. (Effective six months following enactment)

 

Wellness Programs

• Grants are provided for up to five years to small employers that establish wellness programs. (Funds appropriated for five years beginning in fiscal year 2011)
  
• Technical assistance and other resources is provided to evaluate employer-based wellness programs. A national worksite health policies and programs survey will be conducted to assess employer-based health policies and programs. (Conduct study within two years following enactment)
  
• Employers will be permitted to offer employees rewards—in the form of premium discounts, waivers of costsharing requirements, or benefits that would otherwise not be provided—of up to 30% of the cost
  of coverage for participating in a wellness program and meeting certain health-related standards.
  Employers must offer an alternative standard for individuals for whom it is unreasonably difficult or
  inadvisable to meet the standard. The reward limit may be increased to 50% of the cost of coverage if
  deemed appropriate. (Effective January 1, 2014) Establish 10-state pilot programs are to be established by July 2014 to permit participating states to apply similar rewards for participating in wellness programs in the individual market and expand demonstrations in 2017 if effective. Require a report on the effectiveness and impact of wellness programs is required. (Report due three years following enactment)

 

Nutritional Information

Chain restaurants and food sold from vending machines will be required to disclose the nutritional content of each item. (Proposed regulations issued within one year of enactment)

 

 

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