Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; Small Business Health Options Program. Final rule.

PubMed

2013-06-04

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) related to the Small Business Health Options Program (SHOP). Specifically, this final rule amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP.

78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

PubMed

2013-02-27

This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title...

Why the affordable care act needs a better name: 'Americare'.

PubMed

Sage, William M

2010-08-01

The culmination of a century's effort to enact universal coverage in the United States is a law with an uninspiring title, the Patient Protection and Affordable Care Act, and an even more awkward acronym, PPACA. The Obama administration has decided to call the legislation the Affordable Care Act, but the expansion of health coverage that the law sets in motion has no name, and therefore no identity. It badly needs one.

Catching up: Latino health coverage gains and challenges under the Affordable Care Act: results from the Commonwealth Fund Affordable Care Act Tracking Survey.

PubMed

Doty, Michelle M; Rasmussen, Petra W; Collins, Sara R

2014-09-01

For decades, Latinos have had the highest uninsured rates of any racial or ethnic group in the United States. Less than one year after the Affordable Care Act's health insurance marketplaces opened for enrollment, the overall Latino uninsured rate dropped from 36 percent to 23 percent, according to the Commonwealth Fund Affordable Care Act Tracking Survey, conducted April 9 to June 2, 2014. However, the high uninsured rate among Latinos in states that had not expanded their Medicaid program at the time of the survey--33 percent--remained statistically unchanged. These states are home to about 20 million Latinos, the majority of whom live in Texas and Florida.

United States Health Care Reform Progress to Date and Next Steps

PubMed Central

Obama, Barack

2016-01-01

IMPORTANCE The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. OBJECTIVES To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. EVIDENCE Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. FINDINGS The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. CONCLUSIONS AND RELEVANCE Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges. PMID:27400401

United States Health Care Reform: Progress to Date and Next Steps.

PubMed

Obama, Barack

2016-08-02

The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law's reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation's most complex challenges.

Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer.

PubMed

Ellimoottil, Chandy; Miller, David C

2014-02-01

The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

Adaptation of neurological practice and policy to a changing US health-care landscape.

PubMed

Gorelick, Philip B

2016-04-01

Health care in the USA is undergoing a drastic transformation under the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act is driving major health-care policy changes by connecting payment for traditional health-care services to value-based care initiatives and emphasising population health and innovative mechanisms to deliver care. Under the Patient Protection and Affordable Care Act, neurological practice will need to adapt and transform. Therefore, neurological policy should consider employing a new framework for neurological residency training, developing interdisciplinary team approaches to neurological subspecialty care, and strengthening the primary care-neurological specialty care interface to avoid redundancies and other medical waste. Additionally, neurological policy will need to support a more robust review of diagnostic and care pathway use to reduce avoidable expenditures, and test and implement bundled payments for key neurological diagnoses. In view of an anticipated 19% shortage of US neurologists in the next 10 years, development of new neurological policy under the Patient Protection and Affordable Care Act is paramount. Copyright © 2016 Elsevier Ltd. All rights reserved.

Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act.

PubMed

Grace, Aimee M; Horn, Ivor; Hall, Robert; Cheng, Tina L

2015-10-01

The Affordable Care Act has caused and continues to cause sweeping changes throughout the health system in the United States. Poorly explained, complex, controversial, confusing, and subject to continuous legal and regulatory definition, the law stands as a hallmark piece of legislation that will change the health sector in America forever. This article summarizes the Affordable Care Act with a focus on children, families, and disparities. Also provided is the context of the current system of health care coverage in the United States. Published by Elsevier Inc.

45 CFR 156.280 - Segregation of funds for abortion services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS... its essential health benefits, as described in section 1302(b) of the Affordable Care Act, for any... may discriminate against any individual health care provider or health care facility because of its...

45 CFR 156.280 - Segregation of funds for abortion services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS... its essential health benefits, as described in section 1302(b) of the Affordable Care Act, for any... may discriminate against any individual health care provider or health care facility because of its...

Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act.

PubMed

Nyman, John A; Trenz, Helen M

2016-02-01

Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford.

45 CFR 147.140 - Preservation of right to maintain existing coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

45 CFR 147.140 - Preservation of right to maintain existing coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

45 CFR 147.140 - Preservation of right to maintain existing coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

PubMed

2013-02-25

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

75 FR 81662 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

... for OMB Review; Comment Request; Affordable Care Act Patient Protection Notice ACTION: Notice. SUMMARY... Security Administration (EBSA) sponsored information collection request (ICR) titled, ``Affordable Care Act Patient Protection Notice,'' to the Office of Management and Budget (OMB) for review and approval for...

Impact of the Affordable Care Act on stem cell transplantation.

PubMed

Farnia, Stephanie; Gedan, Alicia; Boo, Michael

2014-03-01

The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likely to see new forms of payment reform, particularly in the Medicare program, and narrower commercial provider networks. In addition, the composition of the health insurance market will broaden with the introduction of health insurance exchanges and expanded Medicaid populations in many states. Furthermore, the Patient Protection and Affordable Care Act calls for quality initiatives such as comparative effectiveness research to increase effective, appropriate and high-value care. This paper will review the main provisions of the Patient Protection and Affordable Care Act with specific attention to their impact on the field of Stem Cell Transplantation.

76 FR 28438 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-17

... announced below concerns ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity..., discussion, and evaluation of ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity...

76 FR 11283 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review...) titled, ``Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non... rules relating to internal claims and appeals and external review processes. On July 23, 2010, the EBSA...

Patient Protection and Affordable Care Act; establishment of the multi-state plan program for the Affordable Insurance Exchanges.

PubMed

2013-03-11

The U.S. Office of Personnel Management (OPM) is issuing a final regulation establishing the Multi-State Plan Program (MSPP) pursuant to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). One of the issuers must be non-profit. Under the law, an MSPP issuer may phase in the States in which it offers coverage over 4 years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. This rule aims to balance adhering to the statutory goals of MSPP while aligning its standards to those applying to qualified health plans to promote a level playing field across health plans.

45 CFR 156.155 - Enrollment in catastrophic plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 156.155 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO...(d) of the Affordable Care Act. (3) Provides coverage of the essential health benefits under section...

45 CFR 156.155 - Enrollment in catastrophic plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 156.155 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO...(d) of the Affordable Care Act. (3) Provides coverage of the essential health benefits under section...

Patient Protection and Affordable Care Act; program integrity: exchange, premium stabilization programs, and market standards; amendments to the HHS notice of benefit and payment parameters for 2014. Final rule.

PubMed

2013-10-30

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

76 FR 28790 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial review.

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... announced below concerns Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity... ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity Announcement (FOA) DP11-007, Panel...

Women's Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act.

PubMed

Chuang, Cynthia H; Mitchell, Julie L; Velott, Diana L; Legro, Richard S; Lehman, Erik B; Confer, Lindsay; Weisman, Carol S

2015-11-01

The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration-approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential.

Women’s Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act

PubMed Central

Mitchell, Julie L.; Velott, Diana L.; Legro, Richard S.; Lehman, Erik B.; Confer, Lindsay; Weisman, Carol S.

2015-01-01

The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration–approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential. PMID:26447910

The Affordable Care Act: the ethical call to transform the organizational culture.

PubMed

Piper, Llewellyn E

2014-01-01

The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture.

76 FR 30942 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

... the Patient Protection and Affordable Care Act, Public Law 111-148 (the Affordable Care Act), provides... comply with certain consumer protection provisions contained in the Act. It also will provide important contact information for participants to find out which protections apply and which protections do not...

Diabetes and the Affordable Care Act

PubMed Central

Schade, David S.

2014-01-01

Abstract The Affordable Care Act—“Obamacare”—is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different “metallic” insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. PMID:24927108

77 FR 72581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-05

... least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). Under the... issuers to offer at least two multi-State plans (MSPs) on each of the Exchanges in the 50 States and the... Patient Protection and Affordable Care Act; Establishment of the Multi- State Plan Program for the...

Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

PubMed Central

Sealy-Jefferson, Shawnita; Vickers, Jasmine; Elam, Angela; Wilson, M. Roy

2015-01-01

Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA. PMID:26668787

The Affordable Care Act: The Value of Systemic Disruption

PubMed Central

2013-01-01

It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve. Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care. However, challenges to affordability and cost control persist. Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right. PMID:23409911

Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule.

PubMed

2012-07-20

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

Fostering Health: The Affordable Care Act, Medicaid, and Youth Transitioning from Foster Care. Policy Brief

ERIC Educational Resources Information Center

Wilson-Simmons, Renée; Dworsky, Amy; Tongue, Denzel; Hulbutta, Marikate

2016-01-01

The Affordable Care Act includes language that requires states to provide Medicaid coverage to youth who were in foster care in their state before aging out of the child welfare system. However, most states have interpreted the law differently for youth who move to their state after aging out, determining that automatic Medicaid coverage is an…

Harnessing the Affordable Care Act to catalyze delivery system reform and strengthen emergency care in America.

PubMed

Maa, John

2015-01-01

As health care reform in the US evolves beyond insurance reform to encompass delivery system reform, the opportunity arises to harness the Affordable Care Act to strengthen patient care in America. One area for dedicated individuals to lead this effort is by improving transitions in patient care across the continuum of team members, specialties, settings, and systems. This article will describe innovations of the surgicalist and acute care surgeon that have emerged in response to the challenges facing surgery in specialization, geography, and the need to comply with health care reform mandates. Three ways will be described to integrate these innovations with pilot programs in the Affordable Care Act: to promote teamwork, to reduce readmissions, and to strengthen emergency care because the key location where the joint efforts intersect most acutely with patient need is in our nation's Emergency Departments.

Harnessing the Affordable Care Act to Catalyze Delivery System Reform and Strengthen Emergency Care in America

PubMed Central

Maa, John

2015-01-01

As health care reform in the US evolves beyond insurance reform to encompass delivery system reform, the opportunity arises to harness the Affordable Care Act to strengthen patient care in America. One area for dedicated individuals to lead this effort is by improving transitions in patient care across the continuum of team members, specialties, settings, and systems. This article will describe innovations of the surgicalist and acute care surgeon that have emerged in response to the challenges facing surgery in specialization, geography, and the need to comply with health care reform mandates. Three ways will be described to integrate these innovations with pilot programs in the Affordable Care Act: to promote teamwork, to reduce readmissions, and to strengthen emergency care because the key location where the joint efforts intersect most acutely with patient need is in our nation’s Emergency Departments. PMID:25663212

75 FR 17918 - Advisory Board to the Consumer Operated and Oriented Plan (CO-OP) Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-08

...: The Patient Protection and Affordable Care Act requires the Secretary of Health and Human Services to... program. The Patient Protection and Affordable Care Act gave the Comptroller General of the United States... described in section 1805(c)(2) of the Social Security Act. Appointments are to be made not later than three...

The Affordable Care Act: the ethical call for value-based leadership to transform quality.

PubMed

Piper, Llewellyn E

2013-01-01

Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.

Nursing homes and the affordable care act: a cease fire in the ongoing struggle over quality reform.

PubMed

Hawes, Catherine; Moudouni, Darcy M; Edwards, Rachel B; Phillips, Charles D

2012-01-01

Most provisions in the Affordable Care Act that affect nursing homes originated in two earlier attempts at reform, both of which failed multiple times in prior Congressional sessions: the Elder Justice Act and the Nursing Home Transparency and Improvement Act. Both of these earlier efforts focused on improving quality and reducing elder abuse in nursing homes by strengthening oversight and enforcement penalties, expanding staff training, and increasing the information on nursing home quality available to consumers and regulators. Each bill addressed problems that were serious, widespread, and had persisted for years, but each failed to pass on its own. The Affordable Care Act, with its own momentum, became the vehicle for their passage. However, the reasons the bills failed in these earlier efforts suggest implementation challenges now that they have ridden into law on the coattails of the more general effort to reform the health care sector.

Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces.

PubMed

Cusano, David; Lucia, Kevin

2016-02-01

A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by pro­moting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states--Kansas, Nevada, Rhode Island, and Washington. Strategies include: educating consumers and providing coverage information in one place to ease decision-making; promoting competition among insurers; and ensuring a level playing field for premium rate development through the rate review process.

The widening U.S. health care crisis three years after the passage of 'Obamacare'.

PubMed

Rao, Birju; Hellander, Ida

2014-01-01

This report presents information on the state of the U.S. health system in 2012 and early 2013, specifically the period prior to the implementation of the individual mandate and full rollout of the Affordable Care Act's online health exchanges. The authors include data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, the rising costs of the U.S. health system, and the role of corporate money in health care, with special reference to the pharmaceutical industry. They also provide updates on Medicare health maintenance organizations, Medicaid, and a prelude to the complete implementation of the Affordable Care Act. In addition, the authors include some results from public opinion polls on health systems and international system comparisons. The article concludes with an assessment of the rapid consolidation in the delivery of health care being driven by the Affordable Care Act.

Procedures for the Handling of Retaliation Complaints Under Section 1558 of the Affordable Care Act. Final rule.

PubMed

2016-10-13

This document provides the final text of regulations governing employee protection (retaliation or whistleblower) claims under section 1558 of the Affordable Care Act, which added section 18C to the Fair Labor Standards Act to provide protections to employees who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions (for example, health insurance premium tax credits) or for reporting potential violations of the Affordable Care Act's consumer protections (for example, the prohibition on rescissions). An interim final rule (IFR) governing these provisions and request for comments was published in the Federal Register on February 27, 2013. Thirteen comments were received; eleven were responsive to the IFR. This rule responds to those comments and establishes the final procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary of Labor's (Secretary's) final decision. It also sets forth the Secretary's interpretations of the Affordable Care Act whistleblower provision on certain matters.

78 FR 20581 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-05

... Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance..., training and certification, and meaningful access standards applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non...

77 FR 70583 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

... renewability protections, by prohibiting the use of factors such as health status, medical history, gender, and... comply with the provisions of the final rule, including administrative and marketing costs.... SUMMARY: This proposed rule would implement the Affordable Care Act's policies related to fair health...

The Patient Protection and Affordable Care Act: The Role of the School Nurse. Position Statement

ERIC Educational Resources Information Center

Combe, Laurie G.; Sharpe, Susan; Feeser, Cynthia Jo; Ondeck, Lynnette; Fekaris, Nina

2015-01-01

It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) serves a vital role in the delivery of health care to our nation's students within the healthcare system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as…

Minimum essential coverage and other rules regarding the shared responsibility payment for individuals. Final regulations.

PubMed

2014-11-26

This document contains final regulations relating to the requirement to maintain minimum essential coverage enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the TRICARE Affirmation Act and Public Law 111-173 (collectively, the Affordable Care Act). These final regulations provide individual taxpayers with guidance under section 5000A of the Internal Revenue Code on the requirement to maintain minimum essential coverage and rules governing certain types of exemptions from that requirement.

The 2015 Long-Term Budget Outlook

DTIC Science & Technology

2015-06-17

and an increasing number of recipients of exchange subsidies and Medicaid benefits attributable to the Affordable Care Act would push up spending...for Social Security and the government’s major health care programs—Medicare, Medicaid , the Children’s Health Insurance Program, and subsidies for...number of recipients of exchange subsidies and Medicaid benefits attributable to the Affordable Care Act.  The government’s net outlays for

76 FR 77392 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... to protect CO-OP members against insurance industry involvement and interference. To ensure consumer... Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program... the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation...

45 CFR 156.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

...: Actuarial value (AV) means the percentage paid by a health plan of the percentage of the total allowed costs... 1302(c) of the Affordable Care Act; and (3) A bronze, silver, gold, or platinum level of coverage as... values as defined by section 1302(d)(1) of the Affordable Care Act of plan coverage. Percentage of the...

76 FR 52663 - Notice of Intent To Award Affordable Care Act Funding, DP-09-001

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

... Intent To Award Affordable Care Act Funding, DP-09-001 AGENCY: Centers for Disease Control and Prevention... received and competed in response to CDC Funding Opportunity, RFA-DP-09-001, ``Health Promotion and Disease... for this initiative. Award Information Approximate Current Fiscal Year Funding: $10,000,000. [[Page...

Federal Home Visiting under the Affordable Care Act

ERIC Educational Resources Information Center

Strader, Kathleen; Counts, Jacqueline; Filene, Jill

2013-01-01

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is part of The Patient Protection and Affordable Care Act and provides $1.5 billion over 5 years to states, territories, and tribes with the goal of delivering evidence-based home visiting services as part of a high-quality, comprehensive early childhood system that promotes…

76 FR 54774 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA-DP09-905 AGENCY: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS). ACTION: Notice. SUMMARY: This notice provides notice of CDC's intent to fund continuation cooperative agreement...

Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule.

PubMed

2012-03-23

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).

The Patient Protection and Affordable Care Act - The Role of the School Nurse: Position Statement.

PubMed

2015-07-01

It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as the school nurse) serves a vital role in the delivery of health care to our nation’s students within the health care system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the health care system through three primary goals: expanding access, improving quality, and reducing cost (U.S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save health care dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other health care providers to improve overall health outcomes, including insurance reimbursement for services provided to students.

The Affordable Care Act and hospital chaplaincy: re-visioning spiritual care, re-valuing institutional wholeness.

PubMed

Frierdich, Matthew D

2015-01-01

This article focuses on the institutional dimensions of spiritual care within hospital settings in the context of the Patient Protection and Affordable Care Act of 2010 (ACA), applying policy information and systems theory to re-imagine the value and function of chaplaincy to hospital communities. This article argues that chaplaincy research and practice must look beyond only individual interventions and embrace chaplain competencies of presence, ritual, and communication as foundational tools for institutional spiritual care.

Patient Protection and Affordable Care Act

THOMAS, 111th Congress

Rep. Rangel, Charles B. [D-NY-15

2009-09-17

03/23/2010 Became Public Law No: 111-148. (TXT | PDF) (All Actions) Notes: H.R.4872 makes a number of health-related financing and revenue changes to this bill. Read together, this bill and the health care-related provisions of H.R.4872 are commonly referred to as the Affordable Care Act (ACA). Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

Health Care: Information on Coverage Choices for Servicemembers, Former Servicemembers, and Dependents

DTIC Science & Technology

2014-12-01

drugs, rehabilitative and habilitative services and devices, laboratory services, preventive services and chronic disease management , and pediatric ...the Patient Protection and Affordable Care Act (PPACA) is based on age, income, or other factors. The Centers for Medicare & Medicaid Services (CMS...Services MEC minimum essential coverage PPACA Patient Protection and Affordable Care Act VA Department of Veterans Affairs This is a work of the U.S

Patient Protection and Affordable Care Act; annual eligibility redeterminations for exchange participation and insurance affordability programs; health insurance issuer standards under the Affordable Care Act, including standards related to exchanges. Final rule.

PubMed

2014-09-05

This final rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of their state, while streamlining the consumer experience.

Group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act. Final rules.

PubMed

2012-02-15

These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act.

76 FR 54774 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA-DP10-1014 AGENCY... Funding Opportunity CDC-RFA- DP10-1014. It is the intent of CDC to provide continuation funding to one (1... published in the above referenced REACH CORE Funding Opportunity Announcement (FOA). Award Information...

76 FR 21906 - Notice of Intent To Award Affordable Care Act Funding to Approved Applications Formerly Received...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-19

... Intent To Award Affordable Care Act Funding to Approved Applications Formerly Received in Response to the Centers for Disease Control and Prevention Funding Opportunity IP11-010, ``Enhanced Surveillance for New... response to CDC Funding Opportunity, CDC-RFA-IP11-010, ``Enhanced Surveillance for New Vaccine Preventable...

75 FR 52427 - Guidance for Industry: Questions and Answers Regarding the Effect of Section 4205 of the Patient...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-25

... Affordable Care Act of 2010 (Affordable Care Act) establishes requirements for nutrition labeling of standard..., Rockville, MD 20852. Submit written requests for single copies of the guidance to the Office of Nutrition, Labeling and Dietary Supplements, Center for Food Safety and Applied Nutrition (HFS-820), Food and Drug...

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act.

PubMed

Novak, Priscilla; Anderson, Andrew C; Chen, Jie

2018-05-12

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014-2016, but gaps remain.

How the Patient Protection and Affordable Care Act affects Texas dentists.

PubMed

Oneacre, Lee P

2012-10-01

President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law March 23, 2010 (P.L. 111-148), as arguably the most significant legislative health reform since the creation of Medicare and Medicaid in 1965 (1). Several PPACA provisions will impact dentists as both health care providers and small business owners and employers (2). Overall, the law significantly changes health care financing and facilitates competition in the health insurance market place through the creation of health insurance exchanges (HIX).

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules.

PubMed

2011-08-18

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. In addition, we are finalizing an interim final rule with comment period that implements section 203 of the Medicare and Medicaid Extenders Act of 2010 relating to the treatment of teaching hospitals that are members of the same Medicare graduate medical education affiliated groups for the purpose of determining possible full-time equivalent (FTE) resident cap reductions.

Medicaid expansion under the Affordable Care Act. Implications for insurance-related disparities in pulmonary, critical care, and sleep.

PubMed

Lyon, Sarah M; Douglas, Ivor S; Cooke, Colin R

2014-05-01

The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes. Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. However, several impediments to the implementation of Medicaid's expansion and inadequacies within the Medicaid program itself will lessen its initial impact. In particular, the Supreme Court's decision to void the Affordable Care Act's mandate requiring all states to accept the Medicaid expansion allowed half of the states to forego coverage expansion, leaving millions of low-income individuals without insurance. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers. These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.

Opportunities in the Affordable Care Act to Advance Long-Term Services and Supports: The Role of Rehabilitation Counseling

ERIC Educational Resources Information Center

Caldwell, Joe; Alston, Reginald J.

2012-01-01

The Affordable Care Act includes many new provisions for long-term services and supports (LTSS). Among these are several new options, improvements, and incentives within Medicaid to balance service systems and expand access to home and community-based services. This article discusses some of the major provisions, implementations, and implications…

Awareness, Perceptions, and Communication Needs about the Affordable Care Act across the Life Span

ERIC Educational Resources Information Center

Bergeron, Caroline D.; Friedman, Daniela B.; Sisson, Diana C.; Tanner, Andrea; Kornegay, Vance L.; Owens, Otis L.; Weis, Megan A.; Patterson, Lee L.

2016-01-01

Background: By March 2014, all U.S. citizens were required to have health insurance according to the Affordable Care Act (ACA). Purpose: Study objectives were to explore individuals' opinions, perceptions, and communication sources and needs about the ACA and to assess differences by age group. Methods: In November 2013, 10 1-hour focus groups (5…

78 FR 72321 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

... post all comments received before the close of the comment period on the following Web site as soon as... market Medicaid expansion plans, and seeks comment on how to adjust the geographic cost factor in the... Affordable Care Act, establishes permissible rating factors that may be used to vary the premium rate charged...

Projecting the Unmet Need and Costs for Contraception Services After the Affordable Care Act

PubMed Central

Steinmetz, Erika; Gavin, Lorrie; Rivera, Maria I.; Pazol, Karen; Moskosky, Susan; Weik, Tasmeen; Ku, Leighton

2016-01-01

Objectives. We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions. Methods. We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs. Results. The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states’ current Medicaid expansion plans. Conclusions. The Affordable Care Act increases women’s insurance coverage and improves access to contraceptive services. However, for women who remain uninsured, publicly funded family planning programs may still be needed. PMID:26691128

45 CFR 155.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT... Care Act of 2010 (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of.... Catastrophic plan means a health plan described in section 1302(e) of the Affordable Care Act. Code means the...

77 FR 16501 - Certain Preventive Services Under the Affordable Care Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

...This advance notice of proposed rulemaking announces the intention of the Departments of Health and Human Services, Labor, and the Treasury to propose amendments to regulations regarding certain preventive health services under provisions of the Patient Protection and Affordable Care Act (Affordable Care Act). The proposed amendments would establish alternative ways to fulfill the requirements of section 2713 of the Public Health Service Act and companion provisions under the Employee Retirement Income Security Act and the Internal Revenue Code when health coverage is sponsored or arranged by a religious organization that objects to the coverage of contraceptive services for religious reasons and that is not exempt under the final regulations published February 15, 2012. This document serves as a request for comments in advance of proposed rulemaking on the potential means of accommodating such organizations while ensuring contraceptive coverage for plan participants and beneficiaries covered under their plans (or, in the case of student health insurance plans, student enrollees and their dependents) without cost sharing.

The Patient Protection and Affordable Care Act: opportunities for prevention and public health.

PubMed

Shaw, Frederic E; Asomugha, Chisara N; Conway, Patrick H; Rein, Andrew S

2014-07-05

The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage--and the health benefits of insurance--to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population. Copyright © 2014 Elsevier Ltd. All rights reserved.

75 FR 30917 - Medicare Program; Supplemental Proposed Changes to the Hospital Inpatient Prospective Payment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

...This proposed rule is a supplement to the fiscal year (FY) 2011 hospital inpatient prospective payment systems (IPPS) and long- term care prospective payment system (LTCH PPS) proposed rule published in the May 4, 2010 Federal Register. This supplemental proposed rule would implement certain statutory provisions relating to Medicare payments to hospitals for inpatient services that are contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act). It would also specify statutorily required changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs, and for long-term care hospital costs.

America's Affordable Health Choices Act of 2009

THOMAS, 111th Congress

Rep. Dingell, John D. [D-MI-15

2009-07-14

House - 10/14/2009 Placed on the Union Calendar, Calendar No. 168. (All Actions) Notes: For further action, see H.R.3590, which became Public Law 111-148 on 3/23/2010. H.R.3590, often referred to as the Affordable Care Act, is the bill that became the health care reform law. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

AHCA's Medicaid Cuts Would Harm Students and Threaten State Funding for Postsecondary Education

ERIC Educational Resources Information Center

Pham, Duy; Socolow, David

2017-01-01

On May 4, 2017, the United States House of Representatives narrowly passed the American Health Care Act (AHCA) as a repeal and replacement of the Affordable Care Act (ACA). Independent analyses of the AHCA show that it would leave 23 million more people uninsured by 2026, and make coverage less comprehensive and affordable for millions more. Many…

Behind the scenes of the Patient Protection and Affordable Care Act: the making of a health care co-op.

PubMed

Giaimo, Susan

2013-06-01

A primary goal of the Patient Protection and Affordable Care Act (PPACA) is to reduce the number of uninsured by making health insurance more affordable for small businesses and individuals. Toward that end, the PPACA encourages the creation of nonprofit, member-owned health insurance cooperatives to operate inside each state exchange. Co-ops face significant challenges in entering mature insurance markets, but they also possess unique characteristics that may help them survive and thrive. Using Common Ground Healthcare Cooperative in Wisconsin as a case study, this article traces the origins of co-ops in health care reform at national and state levels and analyzes the political and technical challenges and opportunities facing these organizations.

The patient protection and affordable care act: how will it affect private health insurance for cancer patients?

PubMed

Schwartz, Karyn; Claxton, Gary

2010-01-01

The Patient Protection and Affordable Care Act will make health coverage more available and affordable while also strengthening regulations on the scope of private health insurance coverage. Most of the law's key provisions take effect in 2014, at which time health insurers will be barred from charging more or denying coverage for individuals with a pre-existing condition. Also in 2014, qualifying individuals will receive subsidies to purchase private insurance through newly created health insurance exchanges. New rules related to caps on benefits and stronger rights to appeal insurance company decisions take effect in 2010. In 2014, all insurance policies sold to individuals and small groups will have to cover an essential benefits package defined by the federal government. Although many Patient Protection and Affordable Care Act provisions do not apply to all types of private coverage, overall the law will provide more protections to cancer patients and survivors in the private health insurance marketplace.

Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act.

PubMed

Nipp, Ryan D; Shui, Amy M; Perez, Giselle K; Kirchhoff, Anne C; Peppercorn, Jeffrey M; Moy, Beverly; Kuhlthau, Karen; Park, Elyse R

2018-06-01

Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking. To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act. We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers. We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties. Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not getting medical care also decreased each year (B = 0.35; P = .04). In addition, the proportion of cancer survivors who reported being unable to afford prescription medication decreased each year (B=0.66; P = .004) and the proportion of those unable to afford at least 1 of 6 services decreased each year (B = 0.51; P = .01). Despite higher rates of insurance coverage, cancer survivors reported greater difficulties accessing and affording health care compared with adults without cancer. Importantly, the proportion of survivors reporting these issues continued a downward trend throughout our observation period in the years following the implementation of the Affordable Care Act. Our findings suggest incremental improvement in health care access and affordability after recent health care reform and provide an important benchmark as additional changes are likely to occur in the coming years.

Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation Treatments.

PubMed

McMenamin, Sara B; Yoeun, Sara W; Halpin, Helen A

2018-04-01

Four sections of the Affordable Care Act address the expansion of Medicaid coverage for recommended smoking-cessation treatments for: (1) pregnant women (Section 4107), (2) all enrollees through a financial incentive (1% Federal Medical Assistance Percentage increase) to offer comprehensive coverage (Section 4106), (3) all enrollees through Medicaid formulary requirements (Section 2502), and (4) Medicaid expansion enrollees (Section 2001). The purpose of this study is to document changes in Medicaid coverage for smoking-cessation treatments since the passage of the Affordable Care Act and to assess how implementation has differentially affected Medicaid coverage policies for: pregnant women, enrollees in traditional Medicaid, and Medicaid expansion enrollees. From January through June 2017, data were collected and analyzed from 51 Medicaid programs (50 states plus the District of Columbia) through a web-based survey and review of benefits documents to assess coverage policies for smoking-cessation treatments. Forty-seven Medicaid programs have increased coverage for smoking-cessation treatments post-implementation of the Affordable Care Act by adopting one or more of the four smoking-cessation treatment provisions. Coverage for pregnant women increased in 37 states, coverage for newly eligible expansion enrollees increased in 32 states, and 15 states added coverage and/or removed copayments in order to apply for a 1% increase in the Federal Medical Assistance Percentage. Coverage for all recommended pharmacotherapy and group and individual counseling increased from seven states in 2009 to 28 states in 2017. The Affordable Care Act was successful in improving and expanding state Medicaid coverage of effective smoking-cessation treatments. Many programs are not fully compliant with the law, and additional guidance and clarification from the Centers for Medicare and Medicaid Services may be needed. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The patient protection and affordable care act: what does it mean for mental health services for older adults?

PubMed

Sorrell, Jeanne M

2012-11-01

The U.S. Supreme Court recently upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). It is important to think about how this act will affect mental health services for older adults. The act has the potential to improve health outcomes across all income and age groups. There are specific provisions that are expected to improve care for individuals with mental illness, but there is little information about how these provisions will affect older adults with mental illness. As we move toward implementation of the PPACA, psychiatric nurses need to be aware of myths surrounding the act and to think about changes in the health care system, such as collaborative models of care, that may help identify and overcome barriers to treatment of older adults with mental illness. Copyright 2012, SLACK Incorporated.

The Patient Protection and Affordable Care Act: implications for pediatric pharmacy practice.

PubMed

Vallejos, Ximena; Benavides, Sandra

2013-01-01

The impact of the Patient Protection and Affordable Care Act on the pediatric health care landscape includes expanded health insurance coverage and health care delivery improvements by increasing implementation of patient-centered medical homes and accountable care organizations. These offer opportunities for pharmacists to assume responsibility for the medication-related needs of pediatric patients through pharmacotherapy selection, medication therapy management performance, and medication reconciliation at each transition of care. Medically complex children with at least 2 chronic disease states may be the target population. Studies demonstrating the positive outcomes and cost-effectiveness of pharmacists in pediatric ambulatory care settings are needed.

The patient protection and Affordable Care Act: a primer for hand surgeons.

PubMed

Adkinson, Joshua M; Chung, Kevin C

2014-08-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States health care industry since the inception of the Medicare and Medicaid. Contained within the 10 titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.

Opportunities for oncology in the Patient Protection and Affordable Care Act.

PubMed

Patel, Kavita K; Tran, Lisa

2013-01-01

The Patient Protection and Affordable Care Act (ACA) contains within it three significant legislative constructs: to enhance access to health care, improve quality, and decrease cost. Also known as the Triple Aim, these three simple, yet monumental, goals have been the object of actions to date as well as future implementation efforts. This article will identify sections of the legislation that would directly provide areas of opportunity to improve health and achieve the triple aim for the oncology profession.

Promoting Prevention Through the Affordable Care Act: Workplace Wellness

PubMed Central

Roffenbender, Jason S.; Goetzel, Ron Z.; Millard, Francois; Wildenhaus, Kevin; DeSantis, Charles; Novelli, William

2012-01-01

Public health in the United States can be improved by building workplace “cultures of health” that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public’s health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness. PMID:23237245

76 FR 5774 - Planning and Establishment of Consumer Operated and Oriented Plan Program; Request for Comments...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

...This document is a request for comments regarding the provisions of section 1322 of the Patient Protection and Affordable Care Act (the Affordable Care Act), enacted on March 23, 2010, which requires the Secretary to establish the Consumer Operated and Oriented Plan program. The Secretary of Health and Human Services invites public comments in advance of future rulemaking and grant and loan solicitations.

Health insurance premium tax credit. Final regulations.

PubMed

2013-02-01

This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.These final regulations provide guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit.

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults.

PubMed

Lipton, Brandy J; Decker, Sandra L; Sommers, Benjamin D

2017-04-01

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Anticipated changes in reimbursements for US outpatient emergency department encounters after health reform.

PubMed

Galarraga, Jessica E; Pines, Jesse M

2014-04-01

We study how reimbursements to emergency departments (EDs) for outpatient visits may be affected by the insurance coverage expansion of the Patient Protection and Affordable Care Act as previously uninsured patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. We specified multiple linear regression models to examine differences in the payments, charges, and reimbursement ratios by insurance category. Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. From 2005 to 2010, as a percentage of total ED charges, outpatient ED encounters for Medicaid beneficiaries reimbursed 17% more than for uninsured individuals who will become Medicaid eligible after Patient Protection and Affordable Care Act implementation: 40.0% versus 34.0%, mean absolute difference=5.9%, 95% confidence interval 5.7% to 6.2%. During the same period, the privately insured reimbursed 39% more than for uninsured individuals who will not be Medicaid eligible after Patient Protection and Affordable Care Act implementation: 54.0% versus 38.8%, mean absolute difference=15.2%, 95% confidence interval 12.8% to 17.6%. Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges. Although our study does provide insight into the future, multiple factors will ultimately influence reimbursements after implementation of the act. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act.

PubMed

Fletcher, Rebecca Adkins

2016-03-01

A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co-pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food-processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer-sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high-cost health plans will increase problems with appropriate health care access and medical financial burden for many families. © 2014 by the American Anthropological Association.

The Patient Protection and Affordable Care Act: A Primer for Hand Surgeons

PubMed Central

Adkinson, Joshua M.; Chung, Kevin C.

2014-01-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States healthcare industry since the inception of the Medicare and Medicaid. Contained within the 10 Titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. PMID:25066853

Medicaid/CHIP Program; Medicaid Program and Children's Health Insurance Program (CHIP); Changes to the Medicaid Eligibility Quality Control and Payment Error Rate Measurement Programs in Response to the Affordable Care Act. Final rule.

PubMed

2017-07-05

This final rule updates the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs based on the changes to Medicaid and the Children's Health Insurance Program (CHIP) eligibility under the Patient Protection and Affordable Care Act. This rule also implements various other improvements to the PERM program.

The impact of the Patient Protection and Affordable Care Act on radiology: beyond reimbursement.

PubMed

Krishnaraj, Arun; Norbash, Alexander; Allen, Bibb; Ellenbogen, Paul H; Kazerooni, Ella A; Thorwarth, William; Weinreb, Jeffrey C

2015-01-01

The 2014 ACR Forum focused on the noneconomic implications of the Affordable Care Act on the field of radiology, with specific attention to the importance of the patient experience, the role of radiology in public and population health, and radiology's role in the effort to lower overall health care costs. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to best prepare the radiology community for the rapidly evolving health care landscape. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Anticipating the Impact of the Patient Protection and Affordable Care Act for Patients with Urological Cancer

PubMed Central

Ellimoottil, Chandy; Miller, David C.

2014-01-01

The Affordable Care Act seeks to overhaul the US healthcare system by providing insurance for more Americans, improving the quality of healthcare delivery, and reducing healthcare expenditures. While the law’s intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the ACA, including the proposed insurance expansion, payment and delivery system reforms (e.g. bundled payments and Accountable Care Organizations) and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may impact patients with urological cancers. PMID:24588021

The Affordable Care Act and Implications for Health Care Services for American Indian and Alaska Native Individuals

PubMed Central

Ross, Raven E.; Garfield, Lauren D.; Brown, Derek S.; Raghavan, Ramesh

2016-01-01

American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS. PMID:26548665

Affiliation and Its Benefits to the Hospital and Community.

PubMed

Schneider, Maureen

2016-01-01

As a result of the Affordable Care Act, innovative strategies must be developed and initiated to work with the Affordable Care Act in order to diminish fragmentation of care delivery and thereby improve quality and reduce costs. It is imperative for health care organizations to explore options from mergers and acquisitions to affiliation agreements in order to prepare for business transformation. Since financial strength combined with independent governance and retention of cultural identity may be optimal, a legal transactional structure such as an affiliation is sometimes the best course of action for a health system. This article explores the affiliation process for health care organizations.

Medical Device Innovation in the Era of the Affordable Care Act: The End of Sexy.

PubMed

Mattke, Soeren; Liu, Hangsheng; Orr, Patrick

2016-06-20

In this article, the authors explore why medical device innovation has traditionally been geared so thoroughly toward improving performance, with little regard to cost. They argue that the changing incentives in the health care sector and the move to value-based payment models, accelerated by the implementation of the Affordable Care Act, will force device manufacturers to redirect investments from the spectacular toward the prudent, which they dub "the end of sexy." The authors explore consequences for manufacturers, investors, and policymakers.

Medical Device Innovation in the Era of the Affordable Care Act

PubMed Central

Mattke, Soeren; Liu, Hangsheng; Orr, Patrick

2016-01-01

Abstract In this article, the authors explore why medical device innovation has traditionally been geared so thoroughly toward improving performance, with little regard to cost. They argue that the changing incentives in the health care sector and the move to value-based payment models, accelerated by the implementation of the Affordable Care Act, will force device manufacturers to redirect investments from the spectacular toward the prudent, which they dub “the end of sexy.” The authors explore consequences for manufacturers, investors, and policymakers. PMID:28083437

Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

PubMed

Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

2012-09-01

In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

75 FR 46169 - Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and CY...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These proposed changes would be applicable to services furnished on or after January 1, 2011. In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this proposed rule, we set forth the proposed applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2011. This proposed rule also includes proposals to implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest.

Affordable Care Act and Diabetes Mellitus.

PubMed

Shi, Qian; Nellans, Frank P; Shi, Lizheng

2015-12-01

The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

78 FR 19917 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the... Care and Education Reconciliation Act of 2010 (Pub. L. 111-152, enacted on March 30, 2010), and... Care Act that expand access to health coverage through improvements in Medicaid and the Children's...

Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system.

PubMed

Mechanic, David

2012-02-01

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation should work intensively with the states to implement these new programs and other arrangements and begin to fulfill the many unmet promises of community mental health care.

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

PubMed

Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

2014-07-01

Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit. Final regulations.

PubMed

2015-12-18

This document contains final regulations on the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act, 2011. These final regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges, sometimes called Marketplaces) and claim the health insurance premium tax credit, and Exchanges that make qualified health plans available to individuals and employers.

The Affordable Care Act and Cancer Care Delivery

PubMed Central

Brooks, Gabriel A.; Hoverman, J. Russell; Colla, Carrie H.

2017-01-01

The Affordable Care Act (ACA) has reformed U.S. health care delivery through insurance coverage expansion, experiments in payment design, and funding for patient-centered clinical and health care delivery research. The impact on cancer care specifically has been far-reaching, with new ACA-related programs that encourage coordinated, patient-centered, cost-effective care. Insurance expansions through private exchanges and Medicaid, along with pre-existing condition clauses, have helped over 20 million Americans gain health care coverage. Accountable care organizations, oncology patient-centered medical homes and the Oncology Care Model—all implemented through the Center for Medicare and Medicaid Innovation—have initiated an accelerating shift toward value-based cancer care. Concurrently, evidence for better cancer outcomes and improved quality of cancer care is starting to accrue in the wake of ACA implementation. PMID:28537961

75 FR 50843 - 75th Anniversary of the Social Security Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-18

... old age.'' Our Nation was entrenched in the Great Depression. Unemployment neared 20 percent, and... new health care law, the Affordable Care Act, helps sustain this commitment and improves the long-term...

Critical Care Implications of the Affordable Care Act

PubMed Central

Dogra, Anjali P.; Dorman, Todd

2015-01-01

Objectives To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA. Data Sources and Synthesis Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO). As all of the ACA's provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms. Conclusion The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era. PMID:26565630

Post-acute care and vertical integration after the Patient Protection and Affordable Care Act.

PubMed

Shay, Patrick D; Mick, Stephen S

2013-01-01

The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care services will also vary, resulting in a spectrum of integrative behavior.

A Healthy New World: Emergent Opportunities for Clinical Psychologists in the Patient Protection and Affordable Care Act

PubMed Central

Beidas, Rinad S.; Manderscheid, Ronald W.

2014-01-01

The Patient Protection and Affordable Care Act (ACA) is radically transforming the health and mental health care landscape. Emergent opportunities exist for clinical psychologists to redefine their role in healthcare. We reflect on the Chor and colleagues article (this issue) elucidating key issues for psychologists, and present additional recommendations for consideration. Specifically, we highlight three points: (1) moving beyond just training and hoping; (2) recovery, not just symptom reduction; and (3) it’s a healthy new world. Under each of these points, we suggest tactics for how to achieve these goals. PMID:24954983

Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs.

PubMed

Feldman, Heidi M; Buysse, Christina A; Hubner, Lauren M; Huffman, Lynne C; Loe, Irene M

2015-04-01

The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

PubMed

Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

2018-04-17

The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Medicaid.gov

MedlinePlus

... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

Medicaid Benefits

MedlinePlus

... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... health care expenditures. The ADLSs were first announced in the May 19, 2011 Federal Register (76 FR... Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010... Medicaid Innovation (Innovation Center) for the purpose of examining new ways of delivering health care and...

Overview of the Affordable Care Act's impact on military and veteran mental health services: nine implications for significant improvements in care.

PubMed

Russell, Mark C; Figley, Charles R

2014-01-01

On March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Implications of the ACA on mental health care for 9.7 million military active-duty, reserve, and family members and 22.2 million veterans, as well as 1.3 uninsured veterans, is reviewed in light of a major crisis. The authors trace historical roots of the ACA to the World War II generation and efforts to transform the mental health care system by implementing hard-won war trauma lessons. The authors posit 9 principles reflected in the ACA that represent unfulfilled generational war trauma lessons and potential transformation of the military and national mental health care systems.

Right-wing conspiracy? Socialist plot? The origins of the Patient Protection and Affordable Care Act.

PubMed

Quadagno, Jill

2014-02-01

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible.

Lessons Learned From the Affordable Care Act: The Premium Subsidy Design May Promote Adverse Selection.

PubMed

Graetz, Ilana; McKillop, Caitlin N; Kaplan, Cameron M; Waters, Teresa M

2017-05-01

Since 2014, average premiums for health plans available in the Affordable Care Act marketplaces have increased. We examine how premium price changes affected the amount consumers pay after subsidies for the lowest-cost bronze and silver plans available by age in the federally facilitated exchanges. Between 2015 and 2016, benchmark plan premiums increased in 83.3% of counties. Overall, rising benchmark premiums were associated with lower average after-subsidy premiums for the lowest-cost bronze and silver plans for older subsidy-eligible adults, but with higher after-subsidy premiums for younger adults purchasing the same plans, regardless of income. With recent discussions to replace or overhaul the Affordable Care Act, it is critical that we learn from the successes and failures of the current policy. Our findings suggest that the subsidy design, which makes rising premiums costlier for younger adults looking to purchase an entry-level plan, may be contributing to adverse selection and instability in the marketplace.

Flying beneath the Radar of Health Reform: The Community Living Assistance Services and Supports (CLASS) Act

ERIC Educational Resources Information Center

Miller, Edward Alan

2011-01-01

The Patient Protection and Affordable Care Act attempts to address prevailing deficiencies in long-term care (LTC) financing through the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary LTC insurance program administered by the Federal government. The CLASS Act is intended to supplement rather than supplant…

Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments.

PubMed

Rudnicki, Marek; Armstrong, John H; Clark, Clancy; Marcus, Stuart G; Sacks, Lee; Moser, A James; Reid-Lombardo, K Marie

2016-02-01

The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or "ObamaCare" for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the "pro" and "con" arguments for the expected and unexpected consequences of the ACA on society and surgeons.

76 FR 21431 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

...This final rule makes revisions to the Medicare Advantage (MA) program (Part C) and Prescription Drug Benefit Program (Part D) to implement provisions specified in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) (ACA) and make other changes to the regulations based on our experience in the administration of the Part C and Part D programs. These latter revisions clarify various program participation requirements; make changes to strengthen beneficiary protections; strengthen our ability to identify strong applicants for Part C and Part D program participation and remove consistently poor performers; and make other clarifications and technical changes.

45 CFR 156.235 - Essential community providers.

Code of Federal Regulations, 2013 CFR

2013-10-01

....235 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS Act...

45 CFR 156.235 - Essential community providers.

Code of Federal Regulations, 2012 CFR

2012-10-01

....235 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS Act...

45 CFR 156.235 - Essential community providers.

Code of Federal Regulations, 2014 CFR

2014-10-01

....235 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS Act...

Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act

PubMed Central

Ghitza, Udi E.; Tai, Betty

2014-01-01

Undertreated or untreated substance use disorders (SUD) remain a pervasive, medically-harmful public health problem in the United States, particularly in medically underserved and low-income populations lacking access to appropriate treatment. The need for greater access to SUD treatment was expressed as policy in the Final Rule on standards related to essential health benefits, required to be covered through the 2010 Affordable Care Act (ACA) health insurance exchanges. SUD treatment services have been included as an essential health benefit, in a manner that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Consequently, with the ACA, a vast expansion of SUD-care services in primary care is looming. This commentary discusses challenges and opportunities under the ACA for equipping health care professionals with appropriate workforce training, infrastructure, and resources to support and guide science-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for SUD in primary care. PMID:24583486

The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

PubMed

Miller, Edward Alan

2012-01-01

The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.

The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act.

PubMed

Buck, Jeffrey A

2011-08-01

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and stand-alone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered.

Healthy Libraries Develop Healthy Communities: Public Libraries and their Tremendous Efforts to Support the Affordable Care Act

PubMed Central

Collins, Lydia N.

2015-01-01

This article is about the dedication of public library staff and my role as the Consumer Health Coordinator for the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM MAR) to support outreach efforts for health insurance enrollment under the Patient Protection and Affordable Care Act (ACA). ACA was created in order to ensure that all Americans have access to affordable health care. What we didn’t know is that public libraries across the nation would play such an integral role in the health insurance enrollment process. The National Network of Libraries of Medicine (NN/LM) worked closely with public libraries in order to assist with this new role. As we approach the second enrollment and re-enrollment periods, public libraries are gearing up once again to assist with ACA. PMID:25798077

Crossing 138: two approaches to churn under the Affordable Care Act.

PubMed

Ravel, Gabriel; DeSantis, J Angelo

2014-01-01

A predicted side effect of the Medicaid expansion and state-based Exchanges under the Affordable Care Act is churn. Churn is the shifting into and out of eligibility for insurance affordability programs due to income changes. Because the line between Medicaid and Exchange eligibility is fine -138% of the federal poverty level -millions of Americans are expected to gain and lose eligibility. Frequently, this churning undermines continuity of care, raises costs, and frustrates those affected. This article explores two proposed programs to mitigate the effects of churn: the Basic Health Program and the Bridge Program. This article evaluates both programs' ability to mitigate the effects of churn, the likely side effects to states' implementing them, and legal and practical obstacles to their implementation. It concludes that the Bridge Program is the better approach.

The Patient Protection and Affordable Care Act and the regulation of the health insurance industry.

PubMed

Jha, Saurabh; Baker, Tom

2012-12-01

The Patient Protection and Affordable Care Act is a comprehensive and multipronged reform of the US health care system. The legislation makes incremental changes to Medicare, Medicaid, and the market for employer-sponsored health insurance. However, it makes substantial changes to the market for individual and small-group health insurance. The purpose of this article is to introduce the key regulatory reforms in the market for individual and small-group health insurance and explain how these reforms tackle adverse selection and risk classification and improve access to health care for the hitherto uninsured or underinsured population. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

75 FR 55402 - Proposed Collection; Comment Request for Regulation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-10

... required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently... Care Act Notice of Patient Protection. DATES: Written comments should be received on or before November...-10-Affordable Care Act Notice of Patient Protection. OMB Number: 1545-2181. Regulation Project Number...

Medicare Postacute Care Payment Reforms Have Potential to Improve Efficiency, but May Need Changes to Cut Costs

PubMed Central

Grabowski, David C.; Huckfeldt, Peter J.; Sood, Neeraj; Escarce, José J; Newhouse, Joseph P.

2012-01-01

The Affordable Care Act mandates changes in payment policies for Medicare postacute care services intended to contain spending in the long run and help ensure the program’s financial sustainability. In addition to reducing annual payment increases to providers under the existing prospective payment systems, the act calls for demonstration projects of bundled payment, accountable care organizations, and other strategies to promote care coordination and reduce spending. Experience with the adoption of Medicare prospective payment systems in postacute care settings approximately a decade ago suggests that current reforms could, but need not necessarily, produce such undesirable effects as decreased access for less profitable patients, poorer patient outcomes, and only short-lived curbs on spending. Policy makers will need to be vigilant in monitoring the impact of the Affordable Care Act reforms and be prepared to amend policies as necessary to ensure that the reforms exert persistent controls on spending without compromising the delivery of patient-appropriate postacute services. PMID:22949442

78 FR 28711 - National Women's Health Week, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

... seniors get the medication they need at prices they can afford. These changes are making a real difference for families in every part of our country. Thanks to the Affordable Care Act, working mothers no...

The business of interventional pulmonology.

PubMed

Erb, Christopher T; Ernst, Armin; Michaud, Gaëtane C

2013-09-01

Interventional pulmonologists are regularly asked to perform more complicated and advanced procedures, but reimbursement for the time, effort and skill involved in these procedures has not kept up with other procedural specialties. Further changes in funding and reimbursement are likely under the Affordable Care Act. Understanding and effectively using the current system of funding for interventional pulmonology practices are imperative as we adapt to changing medical needs, legislative mandates, and reimbursement policy. This article reviews the current landscape of insurance and reimbursement in health care and anticipates some changes that might be expected from implementation of the Affordable Care Act. Copyright © 2013 Elsevier Inc. All rights reserved.

Amendment to the interim final rules for group health plans and health insurance coverage relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act. Amendment to interim final rules with request for comments.

PubMed

2010-11-17

This document contains an amendment to interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding status as a grandfathered health plan; the amendment permits certain changes in policies, certificates, or contracts of insurance without loss of grandfathered status.

The Affordable Care Act: overview and implications for county and city behavioral health and intellectual/developmental disability programs.

PubMed

Manderscheid, Ron

2014-01-01

The author begins by reviewing the 5 key intended actions of the Affordable Care Act (ACA)-insurance reform, coverage reform, quality reform, performance reform, and information technology reform. This framework provides a basis for examining how populations served and service programs will change at the county and city levels as a result of the ACA, and how provider staff also will change over time as a result of these developments. The author concludes by outlining immediate next steps for county and city programs.

To repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010.

THOMAS, 113th Congress

Rep. Bachmann, Michele [R-MN-6

2013-01-03

Senate - 05/22/2013 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 78. (All Actions) Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

The Relevance of the Affordable Care Act for Improving Mental Health Care.

PubMed

Mechanic, David; Olfson, Mark

2016-01-01

Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce.

Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs

PubMed Central

Buysse, Christina A.; Hubner, Lauren M.; Huffman, Lynne C.; Loe, Irene M.

2015-01-01

ABSTRACT: The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN. PMID:25793891

A five-year assessment of the affordable care act: market forces still trump the common good in U.S. Health care.

PubMed

Geyman, John P

2015-01-01

The Affordable Care Act (ACA) was enacted in 2010 as the signature domestic achievement of the Obama presidency. It was intended to contain costs and achieve near-universal access to affordable health care of improved quality. Now, five years later, it is time to assess its track record. This article compares the goals and claims of the ACA with its actual experience in the areas of access, costs, affordability, and quality of care. Based on the evidence, one has to conclude that containment of health care costs is nowhere in sight, that more than 37 million Americans will still be uninsured when the ACA is fully implemented in 2019, that many more millions will be underinsured, and that profiteering will still dominate the culture of U.S. health care. More fundamental reform will be needed. The country still needs to confront the challenge that our for-profit health insurance industry, together with enormous bureaucratic waste and widespread investor ownership throughout our market-based system, are themselves barriers to health care reform. Here we consider the lessons we can take away from the ACA's first five years and lay out the economic, social/political, and moral arguments for replacing it with single-payer national health insurance. © The Author(s) 2015 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

Patient Protection and Affordable Care Act; exchange and insurance market standards for 2015 and beyond. Final rule.

PubMed

2014-05-27

This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges (``Exchanges''), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non-formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio (MLR) program. The majority of the provisions in this rule are being finalized as proposed.

International examples of undocumented immigration and the affordable care act.

PubMed

Stutz, Matthew; Baig, Arshiya

2014-08-01

As it stands there is no viable health care option for undocumented immigrants of low socioeconomic status. Even more worrisome is that Affordable Care Act simply does not address this issue with any direct plan. The US is in a very influential time period in terms of undocumented immigration and its relationship with health care. The purpose of this paper is to examine international examples of undocumented immigrant health care and their implications for the United States' undocumented immigrant health care. This study found that physicians in the US must work to prevent the initiation of policies which exclude undocumented immigrants from accessing health care. Exclusionary policies implemented in European nations have had disastrous effects on physicians and patients. This paper examines the implications which similar policies would have if implemented in the US.

Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

PubMed Central

Tai, Betty; Volkow, Nora D.

2016-01-01

Addiction is a chronic brain disease with consequences that remain problematic years after discontinuation of use. Despite this, treatment models focus on acute interventions and are carved out from the main health care system. The Patient Protection and Affordable Care Act (2010) brings the opportunity to change the way substance use disorder (SUD) is treated in the United States. The treatment of SUD must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses. The partnering of the health care system with substance abuse treatment programs could dramatically expand the benefits of prevention and treatment of SUD. Expanding roles of health information technology and nonphysician workforces, such as social workers, are essential to the success of a chronic care model. PMID:23731411

78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-15

...This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

Without the individual mandate, the Affordable Care Act would still cover 23 million; premiums would rise less than predicted.

PubMed

Sheils, John F; Haught, Randall

2011-11-01

Many policy analysts fear that eliminating the individual health insurance mandate and penalty from the Affordable Care Act of 2010 would lead to a "premium spiral," in which healthy people would drop coverage, premiums would soar, and the number of people with coverage would plummet. However, there are other provisions of the law that would greatly mitigate this effect. For example, the subsidies provided in the law to help people purchase coverage through health insurance exchanges would restrain a premium spiral by absorbing much of the impact of premium increases. We estimate that if the mandate were lifted, premiums in the individual market would increase by 12.6 percent-somewhat less than other estimates-with 7.8 million people losing coverage, versus other estimates for coverage loss of 16-24 million people. In sum, the Affordable Care Act would still cover 23 million people who would have been uninsured without the law. Our study suggests that although the mandate would have important effects on premiums and coverage, it might not be essential to the act's successful implementation.

The Impact of the Affordable Care Act on Funding for Newborn Screening Services.

PubMed

Costich, Julia F; Durst, Andrea L

2016-01-01

The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. We performed an extensive review of the refereed literature, federal and state agency reports, relevant organizations' websites, and applicable state laws and regulations; interviewed 28 state and federal officials from August to December 2014; and then assessed the interview findings manually. Although a majority of states had well-established systems for including laboratory-based NBS tests in bundled charges for newborn care, billing practices for critical congenital heart disease and newborn hearing tests were less uniform. Most commonly, birthing facilities either prepaid the costs of laboratory-based tests when acquiring the filter paper kits, or the facilities paid for the tests when the kits were submitted. Some states had separate arrangements for billing Medicaid, and smaller facilities sometimes contracted with hearing test vendors that billed families separately. Although the Affordable Care Act coverage mandate may offset some state NBS funding for the screenings themselves, federal support is still required to assure access to the full range of NBS program services. Limiting reimbursement to the costs of screening tests alone would undermine the common practice of using screening charges to fund follow-up services counseling, and medical food or formula, particularly for low-income families.

78 FR 15877 - Taxable Medical Devices; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

... Medical Devices; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correction to final... on the excise tax imposed on the sale of certain medical devices, enacted by the Health Care and Education Reconciliation Act of 2010 in conjunction with the Patient Protection and Affordable Care Act...

How the affordable care act and mental health parity and addiction equity act greatly expand coverage of behavioral health care.

PubMed

Beronio, Kirsten; Glied, Sherry; Frank, Richard

2014-10-01

The Patient Protection and Affordable Care Act (ACA) will expand coverage of mental health and substance use disorder benefits and federal parity protections to over 60 million Americans. The key to this expansion is the essential health benefit provision in the ACA that requires coverage of mental health and substance use disorder services at parity with general medical benefits. Other ACA provisions that should improve access to treatment include requirements on network adequacy, dependent coverage up to age 26, preventive services, and prohibitions on annual and lifetime limits and preexisting exclusions. The ACA offers states flexibility in expanding Medicaid (primarily to childless adults, not generally eligible previously) to cover supportive services needed by those with significant behavioral health conditions in addition to basic benefits at parity. Through these various new requirements, the ACA in conjunction with Mental Health Parity and Addiction Equity Act (MHPAEA) will expand coverage of behavioral health care by historic proportions.

Does Question Wording Predict Support for the Affordable Care Act? An Analysis of Polling During the Implementation Period, 2010-2016.

PubMed

Holl, Kristen; Niederdeppe, Jeff; Schuldt, Jonathon P

2018-07-01

The Patient Protection and Affordable Care Act (ACA) continues to be the subject of fierce political debate in the United States. Drawing on issue framing theory, together with research on wording effects in survey responding, we tested how common differences in the wording of ACA surveys relate to apparent public support for the law. We report on a content analysis of N = 376 U.S. national opinion surveys fielded during a more than six-year period, beginning 23 March 2010 (when President Obama signed the bill into law) and ending 8 November 2016 (Election Day), and use ordinary least squares (OLS) regression models to predict public support for the law as a function of variation in question wording. We coded questions gauging general sentiment toward the law for differences in issue labeling (e.g., Obamacare, Affordable Care Act), whether or not they referenced particular political entities (e.g., President Obama, Congress) or segments of the public (e.g., You, Your Family), various opinion metrics (e.g., Support, Favor), and different response options (e.g., Repeal, Expand) which we used to model aggregate levels of support. The results revealed several key differences in question wording-for example, generic references to the Healthcare Law were employed much more frequently than Obamacare or Affordable Care Act-a number of which reliably predicted aggregate levels of public support. The discussion considers possible explanations for these patterns and reiterates the value of attending to questionnaire design features when interpreting survey data about politically contentious health policy issues.

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

PubMed

2015-08-17

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

Impacts of the Affordable Care Act on Community Health Centers: Characteristics of New Patients and Early Changes in Delivery of Care.

PubMed

Hatch, Brigit; Smith, Ning; McBurnie, Mary Ann; Quach, Thu; Mayer, Kenneth H; Dunne, Mary J; Cottrell, Erika

2018-05-15

The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each). Post-ACA, clinics delivered 19% more office visits and more visits were reimbursed by Medicaid. The support of CHCs is needed to meet increased demand post-ACA.

Achieving a deeper understanding of the implemented provisions of the Affordable Care Act.

PubMed

Zhang, Shuang Qin; Polite, Blase N

2014-01-01

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010. Since that time, numerous regulations have been promulgated, legal battles continue to be fought and the major provisions of the law are being implemented. In the following article, we outline components of the ACA that are relevant to cancer health care, review current implementation of the new health care reform law, and identify challenges that may lie ahead in the post-ACA era. Specifically, among the things we explore are Medicaid expansion, health insurance exchanges, essential health benefits and preventive services, subsidies, access to clinical trials, the Medicare Part D donut hole, and physician quality payment reform.

75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security Act and 42 CFR 412.103 to receive reasonable cost payments for anesthesia services and related care furnished by nonphysician anesthetists from cost reporting periods beginning on or after October 1, 2010, to December 2, 2010.

Quality Health Care for Children and the Affordable Care Act: A Voltage Drop Checklist

PubMed Central

Wise, Paul H.; Halfon, Neal

2014-01-01

The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The “voltage drop” framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children’s health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation. PMID:25225140

76 FR 26489 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

...This final rule implements a Hospital Inpatient Value-Based Purchasing program (Hospital VBP program or the program) under section 1886(o) of the Social Security Act (the Act), under which value-based incentive payments will be made in a fiscal year to hospitals that meet performance standards with respect to a performance period for the fiscal year involved. The program will apply to payments for discharges occurring on or after October 1, 2012, in accordance with section 1886(o) (as added by section 3001(a) of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act)). Scoring in the Hospital VBP program will be based on whether a hospital meets or exceeds the performance standards established with respect to the measures. By adopting this program, we will reward hospitals based on actual quality performance on measures, rather than simply reporting data for those measures.

76 FR 50931 - Health Insurance Premium Tax Credit

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... Health Insurance Premium Tax Credit AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of... relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and...

77 FR 41048 - Health Insurance Premium Tax Credit; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-12

... Health Insurance Premium Tax Credit; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION... regulations relate to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. DATES: This correction is...

77 FR 23729 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-20

... OMB Review; Comment Request Title: Tribal Personal Responsibility Education Program (Tribal PREP... Affordable Care Act, 2010, also known as health care reform, amends Title V of the Social Security Act (42 U... Personal Responsibility Education Program (PREP). The President signed into law the Patient Protection and...

Rules regarding the health insurance premium tax credit. Final and temporary regulations.

PubMed

2014-07-28

This document contains final and temporary regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act of 2011 and the 3% Withholding Repeal and Job Creation Act. These regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit, and Exchanges that make qualified health plans available to individuals. The text of the temporary regulations in this document also serves as the text of proposed regulations set forth in a notice of proposed rulemaking (REG-104579-13) on this subject in the Proposed Rules section in this issue of the Federal Register.

Three Words and the Future of the Affordable Care Act.

PubMed

Bagley, Nicholas

2015-06-01

As an essential part of its effort to achieve near universal coverage, the Affordable Care Act (ACA) extends sizable tax credits to most people who buy insurance on the newly established health care exchanges. Yet several lawsuits have been filed challenging the availability of those tax credits in the thirty-four states that refused to set up their own exchanges. The lawsuits are premised on a strained interpretation of the ACA that, if accepted, would make a hash of other provisions of the statute and undermine its effort to extend coverage to the uninsured. The courts should reject this latest effort to dismantle a critical feature of the ACA. Copyright © 2015 by Duke University Press.

Integrating community health workers within Patient Protection and Affordable Care Act implementation.

PubMed

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C; Trinh-Shevrin, Chau

2015-01-01

The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.

Physicians, the Affordable Care Act, and primary care: disruptive change or business as usual?

PubMed

Jacobson, Peter D; Jazowski, Shelley A

2011-08-01

The Patient Protection and Affordable Care Act 1 (ACA) presages disruptive change in primary care delivery. With expanded access to primary care for millions of new patients, physicians and policymakers face increased pressure to solve the perennial shortage of primary care practitioners. Despite the controversy surrounding its enactment, the ACA should motivate organized medicine to take the lead in shaping new strategies for meeting the nation's primary care needs. In this commentary, we argue that physicians should take the lead in developing policies to address the primary care shortage. First, physicians and medical professional organizations should abandon their long-standing opposition to non-physician practitioners (NPPs) as primary care providers. Second, physicians should re-imagine how primary care is delivered, including shifting routine care to NPPs while retaining responsibility for complex patients and oversight of the new primary care arrangements. Third, the ACA's focus on wellness and prevention creates opportunities for physicians to integrate population health into primary care practice.

Foreword: Follow-on Biologics: Implementation Challenges and Opportunities.

PubMed

Paradise, Jordan

2011-01-01

This Book of the Seton Hall Law Review presents the contributions to Follow-On Biologics: Implementation Challenges and Opportunities, a one-day roundtable event hosted by Seton Hall University School of Law in the fall of 2010. The roundtable fostered an international dialogue regarding the future of follow-on biologics in the United States resulting from the Patient Protection and Affordable Care Act of March 2010. THE BIOLOGIC PRICE COMPETITION AND INNOVATION ACT OF 2010. The March 23, 2010, enactment of the Patient Protection and Affordable Care Act (PPACA) and the companion Health Care and Education Affordability Reconciliation Act of 2010 ushered in landmark reform of the American health care system. Along with sweeping overhauls of the health care system generally, PPACA also provides a new regulatory challenge for the Food and Drug Administration (FDA). A subtitle within PPACA, the Biologics Price Competition and Innovation Act (BPCIA), bestows upon FDA broad authority to implement an abbreviated approval route to market for biological products (also known as biologics) that are "biosimilar" to an existing marketed product. The brief introduction will provide a basic comparison of biologics and conventional pharmaceutical drugs that will prove central to the FDA's development of this follow-on biologic pathway as well as specifically examine the content and scope of the BPCIA provisions and identify future challenges for the FDA. It will conclude by highlighting details of presentations during the roundtable held at the Seton Hall University School of Law and introduce the two resulting articles contained with this Book of the Seton Hall Law Review.

Did the Affordable Care Act's dependent coverage mandate increase premiums?

PubMed

Depew, Briggs; Bailey, James

2015-05-01

We investigate the impact of the Affordable Care Act's dependent coverage mandate on insurance premiums. The expansion of dependent coverage under the ACA allows young adults to remain on their parent's private health insurance plans until the age of 26. We find that the mandate has led to a 2.5-2.8 percent increase in premiums for health insurance plans that cover children, relative to single-coverage plans. We are able to conclude that employers did not pass on the entire premium increase to employees through higher required plan contributions. Copyright © 2015 Elsevier B.V. All rights reserved.

45 CFR 146.180 - Treatment of non-Federal governmental plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

....180 Section 146.180 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Exclusion of Plans and Enforcement... section 2701 of the PHS Act as codified before enactment of the Affordable Care Act. (ii) Special...

Potentially ineffective care: time for earnest reexamination.

PubMed

Jackson, William L; Sales, Joseph F

2014-01-01

The rising costs and suboptimal quality throughout the American health care system continue to invite critical inquiry, and practice in the intensive care unit setting is no exception. Due to their relatively large impact, outcomes and costs in critical care are of significant interest to policymakers and health care administrators. Measurement of potentially ineffective care has been proposed as an outcome measure to evaluate critical care delivery, and the Patient Protection and Affordable Care Act affords the opportunity to reshape the care of the critically ill. Given the impetus of the PPACA, systematic formal measurement of potentially ineffective care and its clinical, economic, and societal impact merits timely reconsideration.

The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape.

PubMed

Harrington, Mary E

2015-01-01

The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA. Since CHIP started in 1997, millions of lower-income children have secured health insurance coverage and needed care, reducing the financial burdens and stress on their families. States made substantial progress in simplifying enrollment and retention. When implemented optimally, Express Lane Eligibility has the potential to help cover more of the millions of eligible children who remain uninsured. Children move frequently between Medicaid and CHIP, and many experienced a gap in coverage with this transition. CHIP enrollees had good access to care. For nearly every health care access, use, care, and cost measure examined, CHIP enrollees fared better than uninsured children. Access in CHIP was similar to private coverage for most measures, but financial burdens were substantially lower and access to weekend and nighttime care was not as good. The Affordable Care Act coverage options have the potential to reduce uninsured rates among children, but complex transition issues must first be resolved to ensure families have access to affordable coverage, leading many stakeholders to recommend funding for CHIP be continued. Copyright © 2015 Academic Pediatric Association. All rights reserved.

Influence of Medical Insurance Under the Affordable Care Act on Access to Pain Management of the Trauma Patient.

PubMed

Wiznia, Daniel H; Zaki, Theodore; Maisano, Julianna; Kim, Chang-Yeon; Halaszynski, Thomas M; Leslie, Michael P

The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care. Investigators phoned 443 board-certified pain specialists, securing office visits with 235 pain physicians from 8 different states. Appointments for pain management were for a patient who sustained an ankle fracture requiring surgery and experiencing difficulty weaning off opioids. Offices were phoned 4 times assessing responses to the 4 different payment methodologies. Fifty-three percent of pain specialists contacted (235 of 443) were willing to see new patients to manage pain medication. Within the 53% of positive responses, 7.2% of physicians scheduled appointments for Medicaid patients, compared with 26.8% for cash-paying patients, 39.6% for those with Medicare, and 41.3% with Blue Cross (P < 0.0001). There were no differences in appointment access between states that had expanded Medicaid eligibility for low-income adults versus states that had not expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement levels for new patient visits correlated with ability to schedule an appointment or influenced wait times. Access to pain specialists for management of pain medication in the postoperative trauma patient proved challenging. Despite the Affordable Care Act, Medicaid patients still experienced curtailed access to pain specialists and confronted the highest incidence of barriers to receiving appointments.

Health Care Reform and Young Adults' Access to Sexual Health Care: An Exploration of Potential Confidentiality Implications of the Affordable Care Act

PubMed Central

Garcia, Carolyn M.; Long, Sharon K.; Lechner, Kate E.; Lust, Katherine; Eisenberg, Marla E.

2012-01-01

One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parent’s private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults. PMID:22897544

Procedures for the handling of retaliation complaints under section 1558 of the Affordable Care Act. Interim final rule; request for comments.

PubMed

2013-02-27

This document provides the interim final regulations governing the employee protection (whistleblower) provision of section 1558 of the Affordable Care Act, which added section 18C of the Fair Labor Standards Act, to provide protections to employees of health insurance issuers or other employers who may have been subject to retaliation for reporting potential violations of the law's consumer protections (e.g., the prohibition on denials of insurance due to pre-existing conditions) or affordability assistance provisions (e.g., access to health insurance premium tax credits). This interim rule establishes procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary's final decision.

Get Screened

MedlinePlus

... these tips on choosing a doctor you can trust . Make sure you get the results from every ... The Affordable Care Act , the health care reform law passed in 2010, requires most insurance plans to ...

Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda.

PubMed

Shah, Megha K; Heisler, Michele; Davis, Matthew M

2014-02-01

Community health workers (CHWs), who have been shown to be effective in multiple roles in the provision of culturally appropriate health care in a variety of settings, have the potential to be important members of an interdisciplinary health care team. Recent efforts have started to explore how best to integrate CHWs into the health system. However, to date, there has been limited policy guidance, support, or evidence on how best to achieve this on a larger scale. The Patient Protection and Affordable Care Act (ACA), through several provisions, provides a unique opportunity to create a unified framework for workforce integration and wider utilization of CHWs. This review identifies four major opportunities to further the research, advocacy, and policy agenda for CHWs.

Medicaid expansion and access to care among cancer survivors: a baseline overview.

PubMed

Tarazi, Wafa W; Bradley, Cathy J; Harless, David W; Bear, Harry D; Sabik, Lindsay M

2016-06-01

Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to health care services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act. We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states. Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76, 95 % confidence interval [CI] 0.63-0.92, p < 0.05) and higher odds of being unable to see a doctor because of cost (AOR 1.14, 95 % CI 0.98-1.31, p < 0.10). Statistically significant differences were not found for annual checkups. Prior to the passage of the Affordable Care Act, cancer survivors living in expansion states had better access to care than survivors living in non-expansion states. Failure to expand Medicaid could potentially leave many cancer survivors with limited access to routine care. Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.

Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

PubMed

King, Marjorie L

2013-01-01

Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

Structuring payment to medical homes after the affordable care act.

PubMed

Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

2014-10-01

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

Medicaid and Children's Health Insurance Programs: essential health benefits in alternative benefit plans, eligibility notices, fair hearing and appeal processes, and premiums and cost sharing; exchanges: eligibility and enrollment. Final rule.

PubMed

2013-07-15

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark-equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

The impact of policies promoting health information technology on health care delivery in jails and local communities.

PubMed

Butler, Ben; Murphy, Judy

2014-03-01

The 1976 Supreme Court decision in Estelle v. Gamble declared that jails must provide medical treatment to detainees consistent with community standards of care. Yet despite their important role providing health care to about ten million people a year, jails remain largely siloed from the surrounding health care community, compromising inmates' health and adding to health care spending. Health information technology promises solutions. The current policy landscape, shaped by the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act, is favorable to jails' implementation of health information technology (IT). In this article we examine how decisions largely external to jails-coming from the Supreme Court, Congress, and local policy makers-have contributed to the growth of health IT within jails and health information exchange between jails and local communities. We also discuss privacy concerns under the Health Insurance Portability and Affordability Act and other legislation. This article highlights a rare confluence of events that could improve the health of an overlooked population.

77 FR 27281 - Proposed Collection; Comment Request for Form 990 and Schedules

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-09

... 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning... Internal Revenue Code (except black lung benefit trust or private foundation), and schedules. DATES... Care Act (Affordable Care Act), Public Law 111-148, 124 Stat. 119 (March 23, 2010), included new...

76 FR 5861 - Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

... facility ISDEAA Indian Self-Determination and Education Assistance Act LEIE List of Excluded Individuals... and Education Reconciliation Act of 2010 (Pub. L. 111-152) (collectively known as the Affordable Care... information. Sections 6401, 6402, 6501, and 10603 of the ACA and 1304 of the Health Care and Education...

The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

PubMed

Duska, Linda R; Engelhard, Carolyn L

2013-06-01

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. Copyright © 2013 Elsevier Inc. All rights reserved.

76 FR 73025 - Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act

PubMed Central

Ortega, Alexander N.; Rodriguez, Hector P.; Bustamante, Arturo Vargas

2016-01-01

The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos’ health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion; (c) demands on public and private systems of care; and (d) the need to increase the number of Latino physicians while increasing the direct patient-care responsibilities of nonphysician Latino health care workers. PMID:25581154

The Affordable Care Act and Health Insurance Exchanges: Advocacy Efforts for Children's Oral Health.

PubMed

Orynich, C Ashley; Casamassimo, Paul S; Seale, N Sue; Litch, C Scott; Reggiardo, Paul

2015-01-01

To evaluate legislative differences in defining the Affordable Care Act's (ACA) pediatric dental benefit and the role of pediatric advocates across states with different health insurance Exchanges. Data were collected through public record investigation and confidential health policy expert interviews conducted at the state and federal level. Oral health policy change by the pediatric dental profession requires advocating for the mandatory purchase of coverage through the Exchange, tax subsidy contribution toward pediatric dental benefits, and consistent regulatory insurance standards for financial solvency, network adequacy and provider reimbursement. The pediatric dental profession is uniquely positioned to lead change in oral health policy amidst health care reform through strengthening state-level formalized networks with organized dentistry and commercial insurance carriers.

Social welfare and the Affordable Care Act: is it ever optimal to set aside comparative cost?

PubMed

Mortimer, Duncan; Peacock, Stuart

2012-10-01

The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object. Copyright © 2012 Elsevier Ltd. All rights reserved.

Undocumented and uninsured: aftereffects of the Patient Protection and Affordable Care Act.

PubMed

Agabin, Nataly; Coffin, Janis

2015-01-01

Although with the implementation of the Patient Protection and Affordable Care Act millions of previously uninsured American residents will gain access to healthcare coverage, millions more will remain uninsured due to the lack of mandatory state Medicaid expansion as well as mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange. With limited options for healthcare coverage due to employment and lack of citizen status, undocumented immigrants rely heavily on funds provided by both Emergency Medicaid and Disproportionate Share Hospital programs. Through reevaluation of current funding, mandates forbidding access to market exchanges, and plans to further enable access to affordable health coverage, states have the unique opportunity to both aid their residents and relieve the financial burden on healthcare facilities and Emergency Medicaid funds.

Implementing the Affordable Care Act: State Action to Establish SHOP Marketplaces.

PubMed

Dash, Sarah J; Lucia, Kevin W; Thomas, Amy

2014-03-01

The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans. States also are seeking to facilitate small employers' shopping experience through online tools and access to personalized assistance. While not all SHOP marketplaces are yet functioning as intended, their establishment offers an opportunity to identify successful strategies for improving the affordability and accessibility of coverage for small employers.

Health Care Reform: Impact on Total Joint Replacement.

PubMed

Chambers, Monique C; El-Othmani, Mouhanad M; Saleh, Khaled J

2016-10-01

The US health care system has been fragmented for more than 40 years; this model created a need for modification. Sociopoliticomedical system-related factors led to the Affordable Care Act (ACA) and a restructuring of health care provision/delivery. The ACA increases access to high-quality "affordable care" under cost-effective measures. This article provides a comprehensive review of health reform and the motivating factors that drive policy to empower arthroplasty providers to effectively advocate for the field of orthopedics as a whole, and the patients served. Copyright © 2016 Elsevier Inc. All rights reserved.

Public health law: the constitutionality of the Patient Protection and Affordable Care Act.

PubMed

De Ville, Kenneth

2011-01-01

Congress of the Patient Protection and Affordable Care Act (PPACA) was immediately challenged by lawsuits attacking the constitutionality of the legislation. The lawsuits, joined by over 2 dozen state's attorney generals, contend that PPACA is an unconstitutional exercise of federal power. Specifically, the suits argue that the individual insurance mandate portion of the law is justified by neither the "Commerce Power" nor Congress' authority to "tax" and provide for "the general welfare." This essay outlines and analyzes the constitutional arguments for, and against, PPACA forecasting the likely resolution of the debate if the suits reach the US Supreme Court.

CDC Vital Signs: HIV Care Saves Lives

MedlinePlus

... through the Affordable Care Act. Doctors, nurses, and health care systems can Test patients for HIV as a regular part of medical care. Counsel patients who do not have HIV on how to prevent ... or mental health services. Work with health departments to get and ...

Plastic surgery practice models and research aims under the Patient Protection and Affordable Care Act.

PubMed

Giladi, Aviram M; Yuan, Frank; Chung, Kevin C

2015-02-01

As the health care landscape in the United States changes under the Affordable Care Act, providers are set to face numerous new challenges. Although concerns about practice sustainability with declining reimbursement have dominated the dialogue, there are more pressing changes to the health care funding mechanism as a whole that must be addressed. Plastic surgeons, involved in various practice models each with different relationships to hospitals, referring physicians, and payers, must understand these reimbursement changes to dictate adequate compensation in the future. In this article, the authors discuss bundle payments and accountable care organizations, and how plastic surgeons might best engage in these new system designs. In addition, the authors review the value of a focused and driven health-services research agenda in plastic surgery, and the importance of this research in supporting long-term financial stability for the specialty.

Effective Strategies for Affordable Care Act Enrollment in Immigrant-Serving Safety Net Clinics in New Mexico.

PubMed

Getrich, Christina M; García, Jacqueline M; Solares, Angélica; Kano, Miria

2017-01-01

In the new Affordable Care Act (ACA) health care environment, safety-net institutions continue to serve as important sources of culturally appropriate care for different groups of immigrant patients. This article reports on a qualitative study examining the early ACA enrollment experiences of a range of health care providers (n = 29) in six immigrant-serving safety-net clinics in New Mexico. The six clinics configured their ACA enrollment strategies differently with regard to operations, staffing, and outreach. Providers reported a generally chaotic rollout overall and expressed frustration with strategies that did not accommodate patients, provided little training for providers, and engaged in minimal outreach. Conversely, providers lauded strategies that flexibly met patient needs, leveraged trust through strategic use of staff, and prioritized outreach. Findings underscore the importance of using and funding concerted strategies for future enrollment of immigrant patients, such as featuring community health workers and leveraging trust for outreach.

Integrating Biopsychosocial Intervention Research in a Changing Health Care Landscape

ERIC Educational Resources Information Center

Ell, Kathleen; Oh, Hyunsung; Wu, Shinyi

2016-01-01

Objective: Safety net care systems are experiencing unprecedented change from the "Affordable Care Act," Patient-Centered Medical Home (PCMH) uptake, health information technology application, and growing of mental health care integration within primary care. This article provides a review of previous and current efforts in which social…

78 FR 75581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-12

... Mental Health Parity and Addiction Equity Act of 2008; Technical Amendment to External Review for Multi... for the Federal external review process under section 2719(b)(2) of the PHS Act and paragraph (d) of...

The Politics of Native American Health Care and the Affordable Care Act.

PubMed

Skinner, Daniel

2016-02-01

This article examines an important but largely overlooked dimension of the Patient Protection and Affordable Care Act (ACA), namely, its significance for Native American health care. The author maintains that reading the ACA against the politics of Native American health care policy shows that, depending on their regional needs and particular contexts, many Native Americans are well-placed to benefit from recent Obama-era reforms. At the same time, the kinds of options made available by the ACA constitute a departure from the service-based (as opposed to insurance-based) Indian Health Service (IHS). Accordingly, the author argues that ACA reforms--private marketplaces, Medicaid expansion, and accommodations for Native Americans--are best read as potential "supplements" to an underfunded IHS. Whether or not Native Americans opt to explore options under the ACA will depend in the long run on the quality of the IHS in the post-ACA era. Beyond understanding the ACA in relation to IHS funding, the author explores how Native American politics interacts with the key tenets of Obama-era health care reform--especially "affordability"--which is critical for understanding what is required from and appropriate to future Native American health care policy making. Copyright © 2016 by Duke University Press.

Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults.

PubMed

Sommers, Benjamin D; Maylone, Bethany; Blendon, Robert J; Orav, E John; Epstein, Arnold M

2017-06-01

Major policy uncertainty continues to surround the Affordable Care Act (ACA) at both the state and federal levels. We assessed changes in health care use and self-reported health after three years of the ACA's coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. We used a difference-in-differences model with a control group and an instrumental variables model to provide individual-level estimates of the effects of gaining insurance. By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in "excellent" self-reported health. Among adults with chronic conditions, we found improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health. Project HOPE—The People-to-People Health Foundation, Inc.

3 CFR 8594 - Proclamation 8594 of October 29, 2010. National Hospice Month, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

... receive hospice care before first discontinuing treatments to cure their disease. The Affordable Care Act... institutions, government and social service agencies, businesses, nonprofit organizations, and other interested...

Affordable Care Act and Women

MedlinePlus

... quality care for older women, and ends the gender discrimination that requires women to pay more for the ... Coverage Preventive Health Services Improved Medicare Coverage Ending Gender Discrimination in Premiums Expanded Insurance Coverage Endnotes Download "rb. ...

Coverage of Certain Preventive Services Under the Affordable Care Act. Final rules.

PubMed

2015-07-14

This document contains final regulations regarding coverage of certain preventive services under section 2713 of the Public Health Service Act (PHS Act), added by the Patient Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. Section 2713 of the PHS Act requires coverage without cost sharing of certain preventive health services by non-grandfathered group health plans and health insurance coverage. These regulations finalize provisions from three rulemaking actions: Interim final regulations issued in July 2010 related to coverage of preventive services, interim final regulations issued in August 2014 related to the process an eligible organization uses to provide notice of its religious objection to the coverage of contraceptive services, and proposed regulations issued in August 2014 related to the definition of "eligible organization,'' which would expand the set of entities that may avail themselves of an accommodation with respect to the coverage of contraceptive services.

The Affordable Care Act: new opportunities for cardiac rehabilitation in the workplace?

PubMed

Pinkstaff, Sherry O; Arena, Ross; Myers, Jonathan; Kaminsky, Leonard; Briggs, Paige; Forman, Daniel E; Patel, Mahesh J; Cahalin, Lawrence P

2014-08-01

Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks. As a result, the worksite is an appealing location to deliver health care.Cardiac rehabilitation has developed a track record of delivering improved outcomes for patients with CVD. Partnerships between cardiac rehabilitation providers and worksite health programs have the potential to improve referral and participation rates of employees with CVD. The current era of health reform in the United States that has been stimulated by the Affordable Care Act provides an ideal opportunity to reconsider worksite health programs as an essential partner in the health care team.

Achieving public health goals through Medicaid expansion: opportunities in criminal justice, homelessness, and behavioral health with the Patient Protection and Affordable Care Act.

PubMed

DiPietro, Barbara; Klingenmaier, Lisa

2013-12-01

States are currently discussing how (or whether) to implement the Medicaid expansion to nondisabled adults earning less than 133% of the federal poverty level, a key aspect of the Patient Protection and Affordable Care Act. Those experiencing homelessness and those involved with the criminal justice system--particularly when they struggle with behavioral health diagnoses--are subpopulations that are currently uninsured at high rates and have significant health care needs but will become Medicaid eligible starting in 2014. We outline the connection between these groups, assert outcomes possible from greater collaboration between multiple systems, provide a summary of Medicaid eligibility and its ramifications for individuals in the criminal justice system, and explore opportunities to improve overall public health through Medicaid outreach, enrollment, and engagement in needed health care.

Building the Coverage Continuum: The Role of State Medicaid Directors and Insurance Commissioners.

PubMed

Ario, Joel; Bachrach, Deborah

2017-02-01

Issue: The Affordable Care Act has expanded coverage to 20 million newly insured individuals, split between state Medicaid programs and commercially insured marketplaces, with limited integration between the two. The seamless continuum of coverage envisioned by the law is central to achieving the full potential of the Affordable Care Act, but it remains an elusive promise. Goals: To examine the historical and cultural differences between state Medicaid agencies and insurance departments that contribute to this lack of coordination. Findings and Conclusions: Historical and cultural differences must be overcome to ensure continuing access to coverage and care. The authors present two opportunities for insurance and Medicaid officials to work together to advance the continuum of coverage: alignment of regulations for insurers participating in both markets and collaboration on efforts to reform the health care delivery system.

The Affordable Care Act's implications for a public health workforce agenda: taxonomy, enumeration, and the Standard Occupational Classification system.

PubMed

Montes, J Henry; Webb, Susan C

2015-01-01

The Affordable Care Act brings a renewed emphasis on the importance of public health services and those whose occupations are defined by performing the essential public health functions. The Affordable Care Act Prevention and Public Health Fund is a signal to the field that its work is important and critical to the health of the nation. Recent reports by the Institute of Medicine describe the changing dimensions of public health work in primary care integration and the need for enhanced financing of public health as investment. Gaining knowledge about the public health workforce, that is, how many workers there are and what they are doing, is of growing interest and concern for the field. Although enumeration of the public health workforce has been attempted several times by the federal government beginning as early as 1982, it was not until the year 2000 that a major effort was undertaken to obtain more complete information. Limitations that hampered Enumeration 2000 have persisted however. With implementation of the Affordable Care Act and other new ventures, key federal agencies are developing strategies to pursue a systemic and systematic enumeration and consistent taxonomy process. Included in these efforts is use of the Bureau of Labor Statistics, Standard Occupational Classification system. A clear and accurate understanding of the public health workforce and its characteristics is a major challenge. A well-constructed, systematic enumeration process can add to our understanding of the nature and functions of that workforce. In addition, discussion of enumeration must include the need for a consensus within the field that leads to a consistent taxonomy for the public health occupations. This article will provide a stage-setting brief of historical actions regarding enumeration, and it will examine selected enumeration activities taking place currently. It will discuss positive and negative implications facing public health and the potential for enhancing the existing Standard Occupational Classification system to aid enumeration studies.

A review of the literature: differences in outcomes for uninsured versus insured critically ill patients: opportunities and challenges for critical care nurses as the Patient Protection and Affordable Care Act begins open enrollment for all Americans.

PubMed

Dillman, Jedd; Mancas, Bianca; Jacoby, Mandi; Ruth-Sahd, Lisa

2014-01-01

The US health care system stands alone in its uniqueness compared with other industrialized nations. Unlike other developed nations, the United States does not provide universal health care coverage to its citizens. America relies primarily on private health insurance, allowing for protection against the high cost of illness. Because of the economic recession, many Americans cannot afford to pay for private health insurance. Contemporary nursing research is reviewing the question "Is there is a difference in patient outcomes for the critically ill depending upon whether or not they have private health insurance?" By using the Johns Hopkins Nursing Evidence-Based Practice Model (Johns Hopkins Nursing Evidenced-Based Practice Model and Guidelines. 2nd ed. Indianapolis, IN: Sigma Theta Tau International; 2012), 6 articles (level III and IV) were reviewed and summarized. After reviewing all the evidence, it is apparent that there are poorer patient outcomes, more specifically death in the critically ill patient population, if the patient does not have private health insurance. Current recommendations from these studies support the Patient Protection and Affordable Care Act (http://www.ehealthinsurance.com), which will take effect in 2014 and will enable uninsured individuals to have access to medical insurance. This provision can also improve preventative care and overall patient outcomes. This article has implications for the critical care nurse in the following ways: First, it will help the nurse to interpret the implications of the Patient Protection and Affordable Care Act and how it will impact critical care practice; second, it validates the challenges that uninsured patients present to acute health care facilities as they come with more complications and consequently are at greater risk for complications; third, it magnifies that the critical care nurse may see millions of new patients; and fourth, it demonstrates for the critical care nurse how to use the Johns Hopkins Nursing Evidence-Based Practice Model to answer questions.

Young adults' health care utilization and expenditures prior to the Affordable Care Act.

PubMed

Lau, Josephine S; Adams, Sally H; Boscardin, W John; Irwin, Charles E

2014-06-01

To examine young adults' health care utilization and expenditures prior to the Affordable Care Act. We used 2009 Medical Expenditure Panel Survey to (1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and (2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other sociodemographic factors, including race/ethnicity and income. Young adults had (1) significantly lower rates of overall utilization (72%) than other age groups (83%-88%, p < .001), (2) the lowest rate of office-based utilization (55% vs. 67%-77%, p < .001) and (3) higher rate of emergency room visits compared with adolescents (15% vs. 12%, p < .01). Uninsured young adults had high out-of-pocket expenses. Compared with the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/person, p < .001) but essentially the same out-of-pocket expenses ($403 vs. $380/person, p = .57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language, and sex. Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of emergency room visits. The Affordable Care Act provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address noninsurance barriers and ensure equal access to health services. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California.

PubMed

Labovitz, Jonathan M; Kominski, Gerald F

2016-05-01

Because value-based care is critical to the Affordable Care Act success, we forecasted inpatient costs and the potential impact of podiatric medical care on savings in the diabetic population through improved care quality and decreased resource use during implementation of the health reform initiatives in California. We forecasted enrollment of diabetic adults into Medicaid and subsidized health benefit exchange programs using the California Simulation of Insurance Markets (CalSIM) base model. Amputations and admissions per 1,000 diabetic patients and inpatient costs were based on the California Office of Statewide Health Planning and Development 2009-2011 inpatient discharge files. We evaluated cost in three categories: uncomplicated admissions, amputations during admissions, and discharges to a skilled nursing facility. Total costs and projected savings were calculated by applying the metrics and cost to the projected enrollment. Diabetic patients accounted for 6.6% of those newly eligible for Medicaid or health benefit exchange subsidies, with a 60.8% take-up rate. We project costs to be $24.2 million in the diabetic take-up population from 2014 to 2019. Inpatient costs were 94.3% higher when amputations occurred during the admission and 46.7% higher when discharged to a skilled nursing facility. Meanwhile, 61.0% of costs were attributed to uncomplicated admissions. Podiatric medical services saved 4.1% with a 10% reduction in admissions and amputations and an additional 1% for every 10% improvement in access to podiatric medical care. When implementing the Affordable Care Act, inclusion of podiatric medical services on multidisciplinary teams and in chronic-care models featuring prevention helps shift care to ambulatory settings to realize the greatest cost savings.

Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

PubMed Central

Wilson, Michael; Cutler, David

2014-01-01

To better understand the financial viability of hospital emergency departments (EDs), we created national estimates of the cost to hospitals of providing ED care and the associated hospital revenue using hospital financial reports and patient claims data from 2009. We then estimated the effect the Affordable Care Act (ACA) will have on the future profitability of providing ED care. We estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms. PMID:24799576

75 FR 48974 - Notice of Intent To Award Patient Protection and Affordable Care Act Funding to Approved But...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

... (ABU) Formerly Received in Response to the American Recovery and Reinvestment Act of 2009 (ARRA...: --Catalogue of Domestic Assistance Number 93.724 --Recovery Act-Specific Reporting Requirements Recipients of Federal awards from funds authorized under Division A of the Recovery Act must comply with all...

45 CFR 153.500 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance... indirect remuneration), expenditures by the QHP issuer for the QHP for activities that improve health care...

45 CFR 156.110 - EHB-benchmark plan standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

....110 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... newborn care. (5) Mental health and substance use disorder services, including behavioral health treatment...

45 CFR 156.110 - EHB-benchmark plan standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

....110 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... newborn care. (5) Mental health and substance use disorder services, including behavioral health treatment...

Preventive Care Benefits (Affordable Care Act)

MedlinePlus

... Plan See Topics Get Answers Back Enroll in Health Insurance See if you qualify for a Special Enrollment ... Does your business qualify for SHOP? Small Business Health Insurance Tax Credit How to sign up for SHOP ...

Small businesses and the Affordable Care Act of 2010.

PubMed

Collins, Sara R; Davis, Karen; Nicholson, Jennifer L; Stremikis, Kristof

2010-09-01

The Patient Protection and Affordable Care Act (ACA) includes several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit to offset premium costs for firms that offer coverage starting this taxable year, establishment of state-based insurance exchanges that promise to lower administrative costs and pool risk more broadly, and creation of new market rules and an essential benefit standard to protect small firms and their workers. Analysis shows that up to 16.6 million workers are in firms that would be eligible for the tax credit in 2010 to 2013. Over the next 10 years, small businesses and organizations could receive an estimated $40 billion in federal support through the premium credit program.

The ACA's Zero Cost-Sharing Mandate and Trends in Out-of-Pocket Expenditures on Well-Child and Screening Mammography Visits.

PubMed

Kirby, James B; Davidoff, Amy J; Basu, Jayasree

2016-12-01

Starting in September of 2010, the Patient Protection and Affordable Care Act required most health insurance policies to cover evidence-based preventive care with no cost-sharing (no copays, coinsurance, or deductibles). It is unknown, however, whether declines in out-of-pocket costs for preventive services are large enough to prompt increases in utilization, the ultimate goal of the policy. In this study, we use a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. Estimates are made using 2-part interrupted time-series models, with well-woman visits serving as the control group because they were not covered under the zero cost-sharing mandate until after our study period. Results indicate a substantial reduction in out-of-pocket costs attributable to the Affordable Care Act. Between January 2011 and September 2012, the zero cost-sharing mandate reduced per-visit out-of-pocket costs for well-child visits from $18.46 to $8.08 (56%) and out-of-pocket costs for screening mammography visits from $25.43 to $6.50 (74%). No reduction was apparent for well-woman visits. The Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits. To increase preventive service use, research is needed to better understand barriers to obtaining preventive care that are not directly related to cost.

ACA and the Triple Aim: Musings of a Health Care Actuary.

PubMed

McCarthy, Mac

2015-01-01

In 2008, the Institute for Healthcare Improvement (IHI) promulgated the Triple Aim, which advocates simultaneous improvements in patient experiences, improved population health and lower cost per capita. In 2010, the Patient Protection and Affordable Care Act (ACA) promised quality, affordable health care for all Americans. It's fair to assume that the framers of ACA were aware of the Triple Aim, and it is likely that much of ACA was heavily influenced by IHI's positions. So it is reasonable, from time to time, to assess ACA's impact on health care against the Triple Aim principles.

75 FR 70165 - Medicare Program; Request for Information Regarding Accountable Care Organizations and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

..., phone 1-800-743-3951. I. Background The Affordable Care Act seeks to improve the quality of health care services and to lower health care costs by encouraging providers to create integrated health care delivery... incentives for health care providers to enhance health care quality and lower costs. One important delivery...

How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016.

PubMed

Gunja, Munira Z; Collins, Sara R; Doty, Michelle M; Beautel, Sophie

2017-08-01

ISSUE: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law’s major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA’s marketplaces or through Medicaid. GOALS: To examine the effects of ACA health reforms on women’s coverage and access to care. METHOD: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2016. FINDINGS AND CONCLUSIONS: Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010. The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low. Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms.

45 CFR 156.245 - Treatment of direct primary care medical homes.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Treatment of direct primary care medical homes. 156.245 Section 156.245 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING...

The Affordable Care Act and Diabetes Diagnosis and Care: Exploring the Potential Impacts

PubMed Central

Laiteerapong, Neda

2016-01-01

This article reviews available data on the implications of the Affordable Care Act (ACA) for the diagnosis and care of type 2 diabetes. We provide a general overview of the major issues for diabetes diagnosis and care, and describe the policies in the ACA that affect diabetes diagnosis and care. We also estimate that approximately 2.3 million of the 4.6 million people in the USA with undiagnosed diabetes aged 18–64 in 2009–2010 may have gained access to free preventive care under the ACA, which could increase diabetes detection. In addition, we note two factors that may limit the success of the ACA for improving access to diabetes care. First, many states with the highest diabetes prevalence have not expanded Medicaid eligibility, and second, primary care providers may not adequately meet the increase in Medicaid patients because federal funding to increase provider reimbursement for Medicaid visits recently expired. We close by discussing current gaps in the literature and future directions for research on the ACA’s impact on diabetes diagnosis, care, and health outcomes. PMID:26892908

The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities.

PubMed

Bartels, Stephen J; Gill, Lydia; Naslund, John A

2015-01-01

The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.

The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities

PubMed Central

Bartels, Stephen J.; Gill, Lydia; Naslund, John A.

2015-01-01

Abstract The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

The affordable care ACT on loyalty programs for federal beneficiaries.

PubMed

Piacentino, Justin J; Williams, Karl G

2014-02-01

To discuss changes in the law that allow community pharmacy loyalty programs to include and offer incentives to Medicare and Medicaid beneficiaries. The retailer rewards exception of the Patient Protection and Affordable Care Act of 2010 and its change to the definition of remuneration in the civil monetary penalties of the Anti-Kickback Statute now allow incentives to be earned on federal benefit tied prescription out-of-pocket costs. The criteria required to design a compliant loyalty program are discussed. Community pharmacies can now include Medicare and Medicaid beneficiaries in compliant customer loyalty programs, where allowed by state law. There is a need for research directly on the influence of loyalty programs and nominal incentives on adherence.

The Affordable Care Act versus Medicare for All.

PubMed

Seidman, Laurence

2015-08-01

Many problems facing the Affordable Care Act would disappear if the nation were instead implementing Medicare for All - the extension of Medicare to every age group. Every American would be automatically covered for life. Premiums would be replaced with a set of Medicare taxes. There would be no patient cost sharing. Individuals would have free choice of doctors. Medicare's single-payer bargaining power would slow price increases and reduce medical cost as a percentage of gross domestic product (GDP). Taxes as a percentage of GDP would rise from below average to average for economically advanced nations. Medicare for All would be phased in by age. Copyright © 2015 by Duke University Press.

75 FR 75617 - World AIDS Day, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... orientation, gender identity, or socio-economic circumstance--will have unfettered access to high- quality, life-extending care. Signifying a renewed level of commitment and urgency, the National HIV/AIDS... quality care. The Affordable Care Act prohibits insurance companies from using HIV status and other pre...

45 CFR 153.500 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance... for the QHP for activities that improve health care quality as set forth in § 158.150 of this...

The Patient Protection and Affordable Care Act: The Impact on Urologic Cancer Care

PubMed Central

Keegan, Kirk A.; Penson, David F.

2012-01-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the United States. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urological cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. PMID:22819697

Buffering the Uneven Impact of the Affordable Care Act: Immigrant-serving Safety-net Providers in New Mexico.

PubMed

Getrich, Christina M; García, Jacqueline M; Solares, Angélica; Kano, Miria

2018-06-01

We conducted a study in early 2014 to document how the initial implementation of the Affordable Care Act (ACA) affected health care provision to different categories of immigrants from the perspective of health care providers in New Mexico. Though ACA navigators led enrollment, a range of providers nevertheless became involved by necessity, expressing concern about how immigrants were faring in the newly configured health care environment and taking on advocacy roles. Providers described interpreting shifting eligibility and coverage, attending to vulnerable under/uninsured patients, and negotiating new bureaucratic barriers for insured patients. Findings suggest that, like past efforts, this recent reform to the fragmented health care system has perpetuated a condition in which safety-net clinics and providers are left to buffer a widening gap for immigrant patients. With possible changes to the ACA ahead, safety-net providers' critical buffering roles will likely become more crucial, underscoring the necessity of examining their experiences with past reforms. © 2017 by the American Anthropological Association.

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

PubMed Central

Logani, Sachin; Green, Adam; Gasperino, James

2011-01-01

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform. PMID:22110908

Achieving Public Health Goals Through Medicaid Expansion: Opportunities in Criminal Justice, Homelessness, and Behavioral Health With the Patient Protection and Affordable Care Act

PubMed Central

Klingenmaier, Lisa

2013-01-01

States are currently discussing how (or whether) to implement the Medicaid expansion to nondisabled adults earning less than 133% of the federal poverty level, a key aspect of the Patient Protection and Affordable Care Act. Those experiencing homelessness and those involved with the criminal justice system—particularly when they struggle with behavioral health diagnoses—are subpopulations that are currently uninsured at high rates and have significant health care needs but will become Medicaid eligible starting in 2014. We outline the connection between these groups, assert outcomes possible from greater collaboration between multiple systems, provide a summary of Medicaid eligibility and its ramifications for individuals in the criminal justice system, and explore opportunities to improve overall public health through Medicaid outreach, enrollment, and engagement in needed health care. PMID:24148039

The Patient Protection and Affordable Care Act and Reproductive Health: Harnessing Data to Improve Care

PubMed Central

Stulberg, Debra

2013-01-01

The Patient Protection and Affordable Care Act (PPACA) has great potential to improve reproductive health through several components: expanded coverage of people of reproductive age; required coverage of many reproductive health services; and insurance exchange structures that encourage individuals and states to hold plans and providers accountable. These components can work together to improve reproductive health. But in order for this to work, consumers and states need information with which to assess plans. This review article summarizes state contracting theory and argues that states should use this structure to require health plans to collect and report meaningful data that patients, providers, plans, payers, and third-party researchers can access. Now that the Supreme Court has upheld the PPACA and states must set up health insurance exchanges, populations can benefit from improved care and outcomes through data transparency. PMID:23262767

The Patient Protection and Affordable Care Act's provisions regarding medical loss ratios and quality: evidence from Texas.

PubMed

Quast, Troy

2013-01-01

The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies. I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects. Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative. Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.

The Patient Protection and Affordable Care Act of 2010: impact on otolaryngology practice and research.

PubMed

Sun, Gordon H; Davis, Matthew M

2012-05-01

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. Since its passage, the PPACA has led to increased health insurance coverage for millions more Americans, and it includes provisions leading to new avenues for clinical and health services research funding. The legislation also favors development of the primary care specialties and general surgery, increased training of midlevel health care providers, and medical training and service in underserved areas of the United States. However, the PPACA does not effectively engage otolaryngologists in quality improvement, despite modifications to the Physician Quality Reporting System. The legislation also levies a tax on cosmetic procedures, affecting both clinicians and patients. This article reviews the sections of the PPACA that are most pertinent to otolaryngologists and explains how these components of the bill will affect otolaryngologic practice and research over the coming decade.

Employer-Sponsored Health Insurance Coverage Limitations: Results from the Childhood Cancer Survivor Study

PubMed Central

Kirchhoff, Anne C.; Kuhlthau, Karen; Pajolek, Hannah; Leisenring, Wendy; Armstrong, Greg T.; Robison, Leslie L.; Park, Elyse R.

2013-01-01

Purpose The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the United States. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI. Methods We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8. Results Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their pre-existing health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care. Conclusions Childhood cancer survivors face barriers to obtaining employer-sponsored health insurance. While Affordable Care Act provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support. PMID:22717916

Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act.

PubMed

Haeder, Simon F

2014-12-01

The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

PubMed

Dybdal, Kristin; Blewett, Lynn A; Pintor, Jessie Kemmick; Johnson, Kelli

2015-01-01

An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

Small increases to employer premiums could shift millions of people to the exchanges and add billions to federal outlays.

PubMed

Austin, Daniel R; Luan, Anna; Wang, Louise L; Bhattacharya, Jay

2013-09-01

The Affordable Care Act will expand insurance coverage to more than twenty-five million Americans, partly through subsidized private insurance available from newly created health insurance exchanges for people with incomes of 133-400 percent of the federal poverty level. The act will alter the financial incentive structure for employers and influence their decisions on whether or not to offer their employees coverage. These decisions, in turn, will affect federal outlays and revenues through several mechanisms. We model the sensitivity of federal costs for the insurance exchange coverage provision of the Affordable Care Act using the nationally representative Medical Expenditure Panel Survey data set. We assess revenues and subsidy outlays for premiums and cost sharing for individuals purchasing private insurance through exchanges. Our findings show that changing theoretical premium contribution levels by just $100 could induce 2.25 million individuals to transition to exchanges and increase federal outlays by $6.7 billion. Policy makers and analysts should pay especially careful attention to participation rates as the act's implementation continues.

45 CFR 153.500 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... health care quality as set forth in § 158.150 of this subchapter; expenditures by the QHP issuer for the... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance...

45 CFR 156.145 - Determination of minimum value.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 156.145 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO... the expected spending for health care costs in a benefit year so that: (i) Any current year HSA...

45 CFR 156.145 - Determination of minimum value.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 156.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO... the expected spending for health care costs in a benefit year so that: (i) Any current year HSA...

Gaps in health insurance: why so many Americans experience breaks in coverage and how the Affordable Care Act will help: findings from the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011.

PubMed

Collins, Sara R; Robertson, Ruth; Garber, Tracy; Doty, Michelle M

2012-04-01

The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. Early provisions of the Affordable Care Act are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.

45 CFR 156.1105 - Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP...

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Quality...

78 FR 52538 - Office of Direct Service and Contracting Tribes; National Indian Health Outreach and Education...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-23

...-Facilitated Marketplace (FFM). A. Develop an Affordable Care Act/IHCIA Training for the Indian Health Care... types of Marketplaces (SBM), SPM, FFM). 5. Create and disseminate additional training and technical...

76 FR 53474 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... Care Reform Insurance Web Portal Requirements 45 CFR part 159; Use: In accordance with sections 1103... by sections 1103 and 10102 of the Affordable Care Act. Once all of the information is collected from...

76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions Program, which was authorized by section 3026 of the Affordable Care Act. DATES: Proposals will be...

The March to Accountable Care Organizations--How Will Rural Fare?

ERIC Educational Resources Information Center

MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

2011-01-01

Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA)…

Geographical Imbalance of Anesthesia Providers and its Impact On the Uninsured and Vulnerable Populations.

PubMed

Liao, C Jason; Quraishi, Jihan A; Jordan, Lorraine M

2015-01-01

The purpose of this study was to determine if there is a relationship between socioeconomic factors related to geography and insurance type and the distribution of anesthesia provider type. Using the 2012 Area Resource File, the correlation analyses illustrates county median income is a key factor in distinguishing anesthesia provider distribution. Certified registered nurse anesthetists (CRNAs) correlated with lower-income populations where anesthesiologists correlated with higher-income populations. Furthermore, CRNAs correlated more with vulnerable populations such as the Medicaid-eligible population, uninsured population, and the unemployed. Access to health care is multifactorial; however, assuring the population has adequate insurance is one of the hallmark achievements of the Affordable Care Act. Removing barriers to CRNA scope of practice to maximize CRNA services will facilitate meeting the demand by vulnerable populations after full implementation of the Affordable Care Act.

Health insurance exchanges under the Patient Protection and Affordable Care Act: regulatory and design challenges.

PubMed

Hoffmann, Stephanie M

2012-12-01

Under the Patient Protection and Affordable Care Act, all states are required to establish health insurance exchanges, marketplaces where individuals and small businesses can purchase health care coverage. In establishing these exchanges, states must address a range of regulatory and design issues to ensure that their exchanges are sustainable and meet the needs of their populations. The issues include the degree of federal involvement in the management of the exchanges, the overall structure and governance of the exchanges, the requirements for insurance plans to be offered on the exchanges, and the design of the exchanges themselves. Each of these issues will play a crucial role in determining the quality of coverage offered to consumers and how effectively they can access that coverage. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

77 FR 8880 - Agency Information Collection Activities; Proposed Collection; Comment Request; General Licensing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

... Provisions; Section 351(k) Biosimilar Applications AGENCY: Food and Drug Administration, HHS. ACTION: Notice... of information technology. General Licensing Provisions; Section 351(K) Biosimilar Applications On... Affordable Care Act.) Section 351(k) of the PHS Act (42 U.S.C. 262(k)), added by the BPCI Act, sets forth the...

Transforming the Delivery of Care in the Post–Health Reform Era: What Role Will Community Health Workers Play?

PubMed Central

Ro, Marguerite; Villa, Normandy William; Powell, Wayne; Knickman, James R.

2011-01-01

The Patient Protection and Affordable Care Act (PPACA) affords opportunities to sustain the role of community health workers (CHWs). Among myriad strategies encouraged by PPACA are prevention and care coordination, particularly for chronic diseases, chief drivers of increased health care costs. Prevention and care coordination are functions that have been performed by CHWs for decades, particularly among underserved populations. The two key delivery models promoted in the PPACA are accountable care organizations and health homes. Both stress the importance of interdisciplinary, interprofessional health care teams, the ideal context for integrating CHWs. Equally important, the payment structures encouraged by PPACA to support these delivery models offer the vehicles to sustain the role of these valued workers. PMID:22021289

75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... Health Care Reform Insurance Web Portal Requirements AGENCY: Office of the Secretary, HHS. ACTION... Affordable Care Act) was enacted on March 23, 2010. It requires the establishment of an internet Web site (hereinafter referred to as a Web portal) through which individuals and small businesses can obtain information...

76 FR 39110 - Medicare Program; Section 3113: The Treatment of Certain Complex Diagnostic Laboratory Tests...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... access to care, quality of care, health outcomes, and expenditures. DATES: Supporting information to... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5058-N... Tests Demonstration. The Demonstration is mandated by section 3113 of the Affordable Care Act. This...

76 FR 29963 - Rate Increase Disclosure and Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

... be subject to review based on the analysis of the trend in health care costs and rate increases... health insurance issuers regarding disclosure and review of unreasonable premium increases under section... Affordable Care Act (Pub. L. 111-148) was enacted on March 23, 2010; the Health Care and Education...

Health Care and Education Reconciliation Act of 2010

THOMAS, 111th Congress

Rep. Spratt, John M., Jr. [D-SC-5

2010-03-17

03/30/2010 Became Public Law No: 111-152. (TXT | PDF) (All Actions) Notes: The bill makes a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act enacted by H.R.3590 and modifies higher education assistance provisions. Read together, H.R.3590 and the health care-related provisions of this bill are commonly... Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply.

PubMed

Daar, David A; Alvarez-Estrada, Miguel; Alpert, Abigail E

2018-02-01

The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.

Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act

PubMed Central

Abdus, Salam; Mistry, Kamila B.

2015-01-01

Objectives. We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods. We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions. PMID:26447920

Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act.

PubMed

Abdus, Salam; Mistry, Kamila B; Selden, Thomas M

2015-11-01

We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions.

45 CFR 156.1220 - Administrative appeals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1220 Administrative appeals. (a) Requests for reconsideration...

45 CFR 149.1 - Purpose and basis.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Purpose and basis. 149.1 Section 149.1 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS... Affordable Care Act (Pub. L. 111-148). ...

45 CFR 155.1040 - Transparency in coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

....1040 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Certification of Qualified Health Plans § 155.1040 Transparency in coverage. (a) General...

45 CFR 149.1 - Purpose and basis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Purpose and basis. 149.1 Section 149.1 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS... Affordable Care Act (Pub. L. 111-148). ...

78 FR 77632 - Amendments to Excepted Benefits

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

...This document contains proposed rules that would amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, and the Public Health Service Act. Excepted benefits are generally exempt from the health reform requirements that were added to those laws by the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act.

The Voyage of a Navigator An aspiring scholar's inside observations on the Affordable Care Act's rocky roll-out in North Carolina.

PubMed

Tripp, Hollie L

2015-01-01

North Carolina, a federally facilitated marketplace under the Affordable Care Act (ACA), stumbled in 2013 when opening its health-insurance exchange. Trouble was easy to foresee, as North Carolina had instituted a law barring any state agency from assisting enrollment in health-insurance plans made available through the ACA. Trained workers were needed to help citizens and legal immigrants "navigate" to these plans. Some of these "navigators" could be paid with federal funds, but many others had to work as volunteers. I was one of these volunteer navigators. Much went wrong in training, staffing, and operations, but much still was accomplished. Here I report observations, share assessments, and offer suggestions for similarly complex situations.

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

PubMed Central

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C.; Trinh-Shevrin, Chau

2015-01-01

Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models. PMID:25414955

76 FR 76250 - Proposed Revision of the Form M-1

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

...This document announces proposed revisions to the Form M-1, Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs). The revisions can be viewed on the Employee Benefits Security Administration's (EBSA) Web site at www.dol.gov/ebsa. The proposed form is substantively different from previous versions of the Form M-1 and may not be used for filing purposes. Elsewhere in this edition of the Federal Register, EBSA is publishing a Notice of Proposed Rulemaking. Those rules would amend the existing MEWA regulations to implement the registration requirement added to section 101(g) of Title I of the Employee Retirement Income Security Act of 1974, (ERISA), as amended by the Patient Protection and Affordable Care Act (Affordable Care Act) as well as to enhance compliance, enforcement, and protection of employer-sponsored health benefits. The proposed form and the accompanying instructions would facilitate the filing requirements for MEWAs under ERISA.

“Will Employers Drop Health Insurance Coverage because of the Affordable Care Act?” Health Affairs 32(9): 1522–1530

PubMed Central

Buchmueller, Thomas; Carey, Colleen; Levy, Helen G.

2014-01-01

Since the passage of the Affordable Care Act, there has been considerable speculation about how many employers will stop offering health insurance once the major coverage provisions of the Act take effect. While some observers predict little aggregate effect, others believe that 2014 marks the beginning of the end for our current system of employer- sponsored insurance. We address the question “how will employer health insurance offering respond to health reform?” using theoretical and empirical evidence. First, we describe economic models of why employers offer insurance. Second, we recap the relevant provisions of health reform and use our economic framework to consider how they may affect employer offers. Third, we review the various predictions that have been made on this subject. Finally, we offer some observations on interpreting early data from 2014. PMID:24019355

78 FR 79619 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-31

... with section 553(b) and (c) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b) & (c)). However... the finding and the reasons therefor in the notice. Section 553(d) of the APA ordinarily requires a 30...

Medicaid Expansion Under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas.

PubMed

Soni, Aparna; Hendryx, Michael; Simon, Kosali

2017-04-01

To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults' health insurance coverage. Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas. Analyses employed survey weights, adjusted for covariates, and included a set of falsification tests as well as sensitivity analyses. Medicaid expansion under the Affordable Care Act increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas (P < .05), but some of these gains were offset by reductions in individual purchased insurance among rural populations (P < .01). Falsification tests showed that the insurance increases were specific to low-income childless adults, as expected, and were largely insignificant for other populations. The Medicaid expansion increased the probability of having "any insurance" for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations. There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization. © 2017 National Rural Health Association.

Called to Act: Stories of Child Care Advocacy in Our Churches.

ERIC Educational Resources Information Center

Freeman, Margery, Ed.

Experiences of church-based child care advocates are narrated in this booklet. Introductory remarks argue that the National Council of Churches (NCC) must advocate high quality, affordable child care for all children and persuade church members to provide it. Part I tells stories about members' efforts to provide child care services to families:…

45 CFR 156.200 - QHP issuer participation standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 156.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.200 QHP issuer...

45 CFR 156.200 - QHP issuer participation standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 156.200 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.200 QHP issuer...

45 CFR 156.200 - QHP issuer participation standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 156.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.200 QHP issuer...

77 FR 30377 - Health Insurance Premium Tax Credit

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-23

... Health Insurance Premium Tax Credit AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations. SUMMARY: This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education...

The health of healthcare, Part V: Is the very freedom of providers at risk?

PubMed

Waldman, Deane

2014-01-01

When healthcare is fully compliant with the Patient Protection and Affordable Health Care Act, U.S. health care providers lose their one inalienable American right, namely freedom, and can no longer fulfill their fiduciary responsibility to patients.

45 CFR 156.285 - Additional standards specific to SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 156.285 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.285 Additional standards...

45 CFR 155.730 - Application standards for SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.730 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.730 Application standards for SHOP...

45 CFR 155.405 - Single streamlined application.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 155.405 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.405 Single...

45 CFR 156.220 - Transparency in coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.220 Transparency in coverage. (a) Required information...

45 CFR 156.255 - Rating variations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

45 CFR 156.285 - Additional standards specific to SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 156.285 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.285 Additional standards...

45 CFR 155.710 - Eligibility standards for SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.710 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.710 Eligibility standards for SHOP...

45 CFR 155.705 - Functions of a SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.705 Functions of a SHOP. (a) Exchange...

45 CFR 156.255 - Rating variations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

45 CFR 156.220 - Transparency in coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.220 Transparency in coverage. (a) Required information...

45 CFR 156.230 - Network adequacy standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

....230 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.230 Network adequacy standards. (a) General...

45 CFR 156.1215 - Payment and collections processes.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 156.1215 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1215 Payment and collections...

45 CFR 156.255 - Rating variations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

45 CFR 156.220 - Transparency in coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.220 Transparency in coverage. (a) Required information...

45 CFR 155.430 - Termination of coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.430 Termination of coverage...

45 CFR 156.230 - Network adequacy standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

....230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.230 Network adequacy standards. (a) General...

45 CFR 155.405 - Single streamlined application.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.405 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.405 Single...

45 CFR 156.285 - Additional standards specific to SHOP.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 156.285 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.285 Additional standards...

45 CFR 155.710 - Eligibility standards for SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 155.710 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.710 Eligibility standards for SHOP...

45 CFR 155.1000 - Certification standards for QHPs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.1000 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Certification of Qualified Health Plans § 155.1000 Certification standards for QHPs. (a...

45 CFR 155.430 - Termination of coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.430 Termination of coverage...

45 CFR 155.715 - Eligibility determination process for SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

....715 Section 155.715 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.715 Eligibility...

45 CFR 155.705 - Functions of a SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.705 Functions of a SHOP. (a) Exchange...

45 CFR 155.1010 - Certification process for QHPs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.1010 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Certification of Qualified Health Plans § 155.1010 Certification process for QHPs. (a...

45 CFR 155.715 - Eligibility determination process for SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

....715 Section 155.715 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.715 Eligibility...

45 CFR 156.230 - Network adequacy standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

....230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.230 Network adequacy standards. (a) General...

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota.

PubMed

Call, Kathleen Thiede; Lukanen, Elizabeth; Spencer, Donna; Alarcón, Giovann; Kemmick Pintor, Jessie; Baines Simon, Alisha; Gildemeister, Stefan

2015-11-01

We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota's insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota

PubMed Central

Lukanen, Elizabeth; Spencer, Donna; Alarcón, Giovann; Kemmick Pintor, Jessie; Baines Simon, Alisha; Gildemeister, Stefan

2015-01-01

Objectives. We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Methods. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. Results. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota’s insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Conclusions. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future. PMID:26447912

76 FR 19655 - Medicare Program; Waiver Designs in Connection With the Medicare Shared Savings Program and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-07

... Savings Program and the Innovation Center AGENCY: Centers for Medicare & Medicaid Services (CMS) and...) of the Social Security Act (of the Act), as added by the Affordable Care Act (ACA) authorizes the... payment and service delivery models by the Center for Medicare and Medicaid Innovation. This notice with...

Indian Health Care Improvement Reauthorization and Extension Act of 2009

THOMAS, 111th Congress

Sen. Dorgan, Byron L. [D-ND

2009-10-15

Senate - 12/16/2009 Placed on Senate Legislative Calendar under General Orders. Calendar No. 233. (All Actions) Notes: The bill as reported by the Senate Committee on Indian Affairs was enacted into law by reference, and with minor changes, by section 10221 of H.R.3590 (the Patient Protection and Affordable Care Act). Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Education in the Wake of Healthcare Reform: Increasing Primary Care Usage by Individuals Currently Reliant upon Emergency Departments for Care

ERIC Educational Resources Information Center

Tannebaum, Michael; Wilkin, Holley A.; Keys, Jobia

2014-01-01

Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits. Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted…

Childhood Cancer Survivor Study participants' perceptions and understanding of the Affordable Care Act.

PubMed

Park, Elyse R; Kirchhoff, Anne C; Perez, Giselle K; Leisenring, Wendy; Weissman, Joel S; Donelan, Karen; Mertens, Ann C; Reschovsky, James D; Armstrong, Gregory T; Robison, Leslie L; Franklin, Mariel; Hyland, Kelly A; Diller, Lisa R; Recklitis, Christopher J; Kuhlthau, Karen A

2015-03-01

The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered "very important" are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as "very important" (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits. © 2015 by American Society of Clinical Oncology.

Childhood Cancer Survivor Study Participants' Perceptions and Understanding of the Affordable Care Act

PubMed Central

Park, Elyse R.; Kirchhoff, Anne C.; Perez, Giselle K.; Leisenring, Wendy; Weissman, Joel S.; Donelan, Karen; Mertens, Ann C.; Reschovsky, James D.; Armstrong, Gregory T.; Robison, Leslie L.; Franklin, Mariel; Hyland, Kelly A.; Diller, Lisa R.; Recklitis, Christopher J.; Kuhlthau, Karen A.

2015-01-01

Purpose The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Methods Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Results Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered “very important” are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as “very important” (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Conclusion Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits. PMID:25646189

Impact of Patient Protection and Affordable Care Act on academic radiology departments' clinical, research, and education missions.

PubMed

Mansoori, Bahar; Vidal, Lorenna L; Applegate, Kimberly; Rawson, James V; Novak, Ronald D; Ros, Pablo R

2013-10-01

The Patient Protection and Affordable Care Act (ACA) generated significant media attention since its inception. When the law was approved in 2010, the U.S. health care system began facing multiple changes to adapt and to incorporate measures to meet the new requirements. These mandatory changes will be challenging for academic radiology departments (ARDs) since they will need to promote a shift from a volume-focused to a value-focused practice. This will affect all components of the mission of ARDs, including clinical practice, education, and research. A unique key element to success in this transition is to focus on both quality and safety, thus improving the value of radiology in the post-ACA era. Given the changes ARDs will face during the implementation of ACA, suggestions are provided on how to adapt ARDs to this new environment. Copyright © 2013. Published by Elsevier Inc.

Plastic Surgery Practice Models and Research Aims Under the Patient Protection and Affordable Care Act

PubMed Central

Giladi, Aviram M.; Yuan, Frank; Chung, Kevin C.

2014-01-01

As the healthcare landscape in the United States changes under the Affordable Care Act (ACA), providers are set to face numerous new challenges. Although concerns about practice sustainability with declining reimbursement have dominated the dialogue, there are more pressing changes to the healthcare funding mechanism as a whole that must be addressed. Plastic surgeons, involved in various practice models each with different relationships to hospitals, referring physicians, and payers, must understand these reimbursement changes in order to dictate adequate compensation in the future. Here we discuss bundle payments and Accountable Care Organizations (ACOs), and how plastic surgeons might best engage in these new system designs. In addition, we review the value of a focused and driven health-services research agenda in plastic surgery, and the importance of this research in supporting long-term financial stability for the specialty. PMID:25626805

78 FR 66653 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... procedure, Adverse selection, Health care, Health insurance, Health records, Organization and functions... practice and procedure, Claims, Health care, Health insurance, Health plans, penalties, Reporting and... DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 153, 155, 156, 157, and 158 [CMS-9964-F3] RIN...

77 FR 29235 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b... incorporates a statement of the finding and the reasons therefore in the notice. Section 553(d) of the APA...

78 FR 78968 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention... Disclosure and Review Reporting Requirements CMS-724 Medicare/Medicaid Psychiatric Hospital Survey Data Under... Reporting Requirements; Use: Section 1003 of the Affordable Care Act adds a new section 2794 of the PHS Act...

78 FR 60877 - Advisory Committee on Immunization Practices (ACIP)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Advisory... Affordable Care Act, at section 2713 of the Public Health Service Act, immunization recommendations of the... covered by applicable health plans. Matters To Be Discussed: The agenda will include discussions on: child...

77 FR 60439 - Notice of the Award of Single-Source Program Expansion Supplements to Multiple Grantees Under the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Grand Island NE 125,000 Office of Minority Health Concord NH 125,000 Department of Health and Human... Act, as amended by Section 5507 of the Affordable Care Act (Pub. L. 111-148). Earl S. Johnson...

An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act

PubMed Central

Kwan, Bethany M.; Valeras, Aimee B.; Levey, Shandra Brown; Nease, Donald E.; Talen, Mary E.

2015-01-01

The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability. PMID:29546130

The Patient Protection and Affordable Care Act: the impact on urologic cancer care.

PubMed

Keegan, Kirk A; Penson, David F

2013-10-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the USA. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urologic cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. Published by Elsevier Inc.

The U.S. Health Care Crisis Five Years After Passage of the Affordable Care Act: A Data Snapshot.

PubMed

Hellander, Ida

2015-01-01

Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform. © The Author(s) 2015.

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

PubMed

2012-08-31

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

Quality and safety in medical care: what does the future hold?

PubMed

Liang, Bryan A; Mackey, Tim

2011-11-01

The rapid changes in health care policy, embracing quality and safety mandates, have culminated in programs and initiatives under the Patient Protection and Affordable Care Act. To review the context of, and anticipated quality and patient safety mandates for, delivery systems, incentives under health care reform, and models for future accountability for outcomes of care. Assessment of the provisions of Patient Protection and Affordable Care Act, other reform efforts, and reform initiatives focusing on future quality and safety provisions for health care providers. Health care reform and other efforts focus on consumerism in the context of price. Quality and safety efforts will be structured using financial incentives, best-practices research, and new delivery models that focus on reaching benchmarks while reducing costs. In addition, patient experience will be a key component of reimbursement, and a move toward "retail" approaches directed at the individual patient may supplant traditional "wholesale" efforts at attracting employers. Quality and safety have always been of prime importance in medicine. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.

Affordable Care Act Provision Lowered Out-Of-Pocket Cost And Increased Colonoscopy Rates Among Men In Medicare.

PubMed

Hamman, Mary K; Kapinos, Kandice A

2015-12-01

Colorectal cancer screening is one of the few cancer screenings with an "A" rating from the US Preventive Services Task Force, meaning that the procedure confers a substantial health benefit. However, 40 percent of people who should receive colorectal cancer screenings do not receive them. Colonoscopies are the most thorough method of screening because they allow physicians to view the entire length of the colon and remove polyps as needed. Billing methods that distinguish between screening and therapeutic procedures have kept expected colonoscopy costs high. However, the Affordable Care Act partially closed the so-called colonoscopy loophole and reduced expected out-of-pocket expenses for all Medicare beneficiaries. Using data from the Behavioral Risk Factor Surveillance System, we found that annual colonoscopy rates among men ages 66-75 increased significantly (by 4.0 percentage points) after the Affordable Care Act policy change, and we found some evidence of even larger increases among socioeconomically disadvantaged men. We found no significant increases among women, a result that may be explained by health behavior and other factors and that requires further study. Our research indicates that cost may be an important barrier to colorectal cancer screening, at least among men, and that making further policy changes to close remaining loopholes may improve screening rates. Project HOPE—The People-to-People Health Foundation, Inc.

Medicare program; payment policies under the physician fee schedule, five-year review of work relative value units, clinical laboratory fee schedule: signature on requisition, and other revisions to part B for CY 2012. Final rule with comment period.

PubMed

2011-11-28

This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

45 CFR 156.260 - Enrollment periods for qualified individuals.

Code of Federal Regulations, 2014 CFR

2014-10-01

....260 Section 156.260 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.260 Enrollment periods...

45 CFR 156.130 - Cost-sharing requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.130 Cost-sharing requirements. (a) Annual limitation on cost sharing. (1...

45 CFR 156.265 - Enrollment process for qualified individuals.

Code of Federal Regulations, 2014 CFR

2014-10-01

....265 Section 156.265 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.265 Enrollment process...

45 CFR 156.290 - Non-renewal and decertification of QHPs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 156.290 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.290 Non-renewal and...

45 CFR 156.140 - Levels of coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.140 Levels of coverage. (a) General requirement for levels of coverage. AV...

45 CFR 153.530 - Risk corridors data requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 153.530 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153.530 Risk corridors...

45 CFR 153.530 - Risk corridors data requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 153.530 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153.530 Risk corridors...

45 CFR 156.225 - Marketing and Benefit Design of QHPs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 156.225 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.225 Marketing and Benefit...

45 CFR 156.265 - Enrollment process for qualified individuals.

Code of Federal Regulations, 2012 CFR

2012-10-01

....265 Section 156.265 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.265 Enrollment process...

45 CFR 156.210 - QHP rate and benefit information.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 156.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

45 CFR 156.1240 - Enrollment process for qualified individuals.

Code of Federal Regulations, 2013 CFR

2013-10-01

....1240 Section 156.1240 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1240 Enrollment process for...

45 CFR 156.225 - Marketing and Benefit Design of QHPs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 156.225 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.225 Marketing and Benefit...

45 CFR 153.600 - [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false [Reserved] 153.600 Section 153.600 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer...

45 CFR 156.340 - Standards for downstream and delegated entities.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... 156.340 Section 156.340 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Federally-Facilitated Exchange Qualified Health Plan Issuer Standards § 156...

45 CFR 156.210 - QHP rate and benefit information.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 156.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

45 CFR 153.600 - [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false [Reserved] 153.600 Section 153.600 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer...

45 CFR 156.270 - Termination of coverage for qualified individuals.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... 156.270 Section 156.270 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.270 Termination...

45 CFR 156.1255 - Renewal and re-enrollment notices.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 156.1255 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1255 Renewal and re-enrollment...

45 CFR 156.270 - Termination of coverage for qualified individuals.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... 156.270 Section 156.270 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.270 Termination...

45 CFR 155.725 - Enrollment periods under SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

....725 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.725 Enrollment periods under SHOP. (a) General...

45 CFR 156.210 - QHP rate and benefit information.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 156.210 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

45 CFR 153.530 - Risk corridors data requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 153.530 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153.530 Risk corridors...

45 CFR 156.130 - Cost-sharing requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.130 Cost-sharing requirements. (a) Annual limitation on cost sharing. (1...

45 CFR 156.270 - Termination of coverage for qualified individuals.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... 156.270 Section 156.270 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.270 Termination...

45 CFR 156.260 - Enrollment periods for qualified individuals.

Code of Federal Regulations, 2013 CFR

2013-10-01

....260 Section 156.260 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.260 Enrollment periods...

45 CFR 156.115 - Provision of EHB.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.115 Provision of EHB. (a) Provision of EHB means that a health plan...

45 CFR 153.600 - [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false [Reserved] 153.600 Section 153.600 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer...

45 CFR 156.1240 - Enrollment process for qualified individuals.

Code of Federal Regulations, 2014 CFR

2014-10-01

....1240 Section 156.1240 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1240 Enrollment process for...

45 CFR 156.225 - Marketing and Benefit Design of QHPs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 156.225 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.225 Marketing and Benefit...

45 CFR 156.290 - Non-renewal and decertification of QHPs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 156.290 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.290 Non-renewal and...

45 CFR 156.290 - Non-renewal and decertification of QHPs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 156.290 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.290 Non-renewal and...

45 CFR 156.115 - Provision of EHB.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.115 Provision of EHB. (a) Provision of EHB means that a health plan...

45 CFR 156.265 - Enrollment process for qualified individuals.

Code of Federal Regulations, 2013 CFR

2013-10-01

....265 Section 156.265 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.265 Enrollment process...

45 CFR 156.340 - Standards for downstream and delegated entities.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... 156.340 Section 156.340 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Federally-Facilitated Exchange Qualified Health Plan Issuer Standards § 156...

45 CFR 156.140 - Levels of coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.140 Levels of coverage. (a) General requirement for levels of coverage. AV...

45 CFR 156.260 - Enrollment periods for qualified individuals.

Code of Federal Regulations, 2012 CFR

2012-10-01

....260 Section 156.260 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.260 Enrollment periods...

Providing Health Information to Latino Farmworkers: The Case of the Affordable Care Act.

PubMed

Arcury, Thomas A; Jensen, Anna; Mann, Mackenzie; Sandberg, Joanne C; Wiggins, Melinda F; Talton, Jennifer W; Hall, Mark A; Quandt, Sara A

2017-01-01

Providing health program information to vulnerable communities, such as Latino farmworkers, is difficult. This analysis describes the manner in which farmworkers receive information about the Affordable Care Act, comparing farmworkers with other Latinos. Interviews were conducted with 100 Latino farmworkers and 100 urban Latino North Carolina residents in 2015. Most farmworkers had received health information from a community organization. Trusted sources for health information were health care providers and community organizations. Sources that would influence decisions to enroll were Latino nurses and doctors, religious leaders, and family members. Traditional media, including oral presentation and printed material at the doctor's office, were preferred by the majority of farmworkers and non-farmworkers. Farmworkers used traditional electronic media: radio, television, and telephone. More non-farmworkers used current electronic media: e-mail and Internet. Latino farmworkers and non-farmworkers prefer traditional media in the context of a health care setting. They are willing to try contemporary electronic media for this information.

Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings.

PubMed

French, Michael T; Homer, Jenny; Gumus, Gulcin; Hickling, Lucas

2016-10-01

To conduct a systematic literature review of selected major provisions of the Affordable Care Act (ACA) pertaining to expanded health insurance coverage. We present and synthesize research findings from the last 5 years regarding both the immediate and long-term effects of the ACA. We conclude with a summary and offer a research agenda for future studies. We identified relevant articles from peer-reviewed scholarly journals by performing a comprehensive search of major electronic databases. We also identified reports in the "gray literature" disseminated by government agencies and other organizations. Overall, research shows that the ACA has substantially decreased the number of uninsured individuals through the dependent coverage provision, Medicaid expansion, health insurance exchanges, availability of subsidies, and other policy changes. Affordability of health insurance continues to be a concern for many people and disparities persist by geography, race/ethnicity, and income. Early evidence also indicates improvements in access to and affordability of health care. All of these changes are certain to ultimately impact state and federal budgets. The ACA will either directly or indirectly affect almost all Americans. As new and comprehensive data become available, more rigorous evaluations will provide further insights as to whether the ACA has been successful in achieving its goals. © Health Research and Educational Trust.

Pharmacy waste, fraud, and abuse in health care reform.

PubMed

Carpenter, Laura A; Edgar, Zachary; Dang, Christopher

2011-01-01

To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R. 4872, and applicable existing and proposed regulations. Waste, fraud, and abuse are substantial threats to the efficiency of the health care system. To combat these activities, the Department of Health and Human Services and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the proper assessment and billing for Medicare and Medicaid services. These guidelines have a number of provisions that can catch even well-intentioned providers off guard, resulting in substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to apprise pharmacists of the substantial changes affecting their practice. H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and Stark Law; and create or extend auditing and management programs. Properly navigating these changes will be important in keeping pharmacies in compliance.

78 FR 8456 - Coverage of Certain Preventive Services Under the Affordable Care Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... 2713 of the Public Health Service Act requires coverage without cost sharing of certain preventive... Requirement to Cover Contraceptive Services Without Cost Sharing Under Section 2713 of the Public Health..., non-stock, public benefit, and similar types of corporations. However, for this purpose an...

The second act. With Obama and the reform law here to stay, big decisions are ahead for healthcare.

PubMed

Daly, Rich; Zigmond, Jessica

2012-11-12

The re-election of President Barack Obama to a second term and the preservation of a Democratic majority in the Senate removed doubts about the survival of the Patient Protection and Affordable Care Act as the law of the land.

75 FR 43182 - Voluntary Registration by Authorized Officials of Non-Covered Retail Food Establishments and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-23

... Act) established requirements for nutrition labeling of standard menu items for restaurants and..., pending promulgation of regulations. FDA is issuing this notice to assist restaurants and similar retail... INFORMATION: I. Background Section 4205 of the Affordable Care Act (Public Law 111-148) requires restaurants...

75 FR 75884 - Regulations Regarding Income-Related Monthly Adjustment Amounts to Medicare Beneficiaries...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-07

... premiums. This new subpart implements changes made to the Social Security Act (Act) by the Affordable Care... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 418 [Docket No. SSA-2010-0029] RIN 0960-AH22... Coverage Premiums AGENCY: Social Security Administration. ACTION: Interim final rule with request for...

Did Health Care Reform Help Kentucky Address Disparities in Coverage and Access to Care among the Poor?

PubMed

Benitez, Joseph A; Adams, E Kathleen; Seiber, Eric E

2018-06-01

To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty. Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011-2015. We use a difference-in-differences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes. Much of the reduction in Kentucky's uninsured rate appears driven by large uptakes in coverage from areas with higher concentrations of poverty. Residents in high-poverty communities experienced larger reductions, 8 percentage points (pp) in uninsured status and 7.5 pp in reporting unmet needs due to costs, than residents of lower poverty areas. These effects helped remove pre-ACA disparities in uninsured rates across these areas. Because we observe positive effects on coverage and reductions in financial barriers to care among those from poorer communities, our findings suggest that expanding Medicaid helps address the health care needs of the impoverished. © Health Research and Educational Trust.

Job mobility among parents of children with chronic health conditions: Early effects of the 2010 Affordable Care Act.

PubMed

Chatterji, Pinka; Brandon, Peter; Markowitz, Sara

2016-07-01

We examine the effects of the 2010 Patient Protection and Affordable Care Act's (ACA) prohibition of preexisting conditions exclusions for children on job mobility among parents. We use a difference-in-difference approach, comparing pre-post policy changes in job mobility among privately-insured parents of children with chronic health conditions vs. privately-insured parents of healthy children. Data come from the 2004 and 2008 Survey of Income and Program Participation (SIPP). Among married fathers, the policy change is associated with about a 0.7 percentage point, or 35 percent increase, in the likelihood of leaving an employer voluntarily. We find no evidence that the policy change affected job mobility among married and unmarried mothers. Copyright © 2016 Elsevier B.V. All rights reserved.

Limited impact on health and access to care for 19- to 25-year-olds following the Patient Protection and Affordable Care Act.

PubMed

Kotagal, Meera; Carle, Adam C; Kessler, Larry G; Flum, David R

2014-11-01

The Patient Protection and Affordable Care Act (PPACA) allowed young adults to remain on their parents' insurance until 26 years of age. Reports indicate that this has expanded health coverage. To evaluate coverage, access to care, and health care use among 19- to 25-year-olds compared with 26- to 34-year-olds following PPACA implementation. Data from the Behavior Risk Factor Surveillance System and the National Health Interview Survey, which provide nationally representative measures of coverage, access to care, and health care use, were used to conduct the study among participants aged 19 to 25 years (young adults) and 26 to 34 years (adults) in 2009 and 2012. Self-reported health insurance coverage. Health status, presence of a usual source of care, and ability to afford medications, dental care, or physician visits. Health coverage increased between 2009 and 2012 for 19- to 25-year-olds (68.3% to 71.7%). Using a difference-in-differences (DID) approach, after adjustment, the likelihood of having a usual source of care decreased in both groups but more significantly for 26- to 34-year-olds (DID, 2.8%; 95% CI, 0.45 to 5.15). There was no significant change in health status for 19- to 25-year-olds compared with 26- to 34-year-olds (DID, -0.5%; 95% CI, -1.87 to 0.87). There was no significant change for 19- to 25-year-olds compared with 26- to 34-year-olds in the percentage who reported receiving a routine checkup in the past year (DID, 0.3%; 95% CI, -2.25 to 2.85) or in the ability to afford prescription medications (DID, -0.4%; 95% CI, -2.93 to 1.93), dental care (DID, -2.6%; 95% CI, -5.61 to 0.61), or physician visits (DID, -1.7%; 95% CI, -3.66 to 0.26). There was also no change in the percentage who reported receiving a flu shot (DID, 1.9; 95% CI, -1.93 to 4.93). Insured individuals were more likely to report having a usual source of care and a recent routine checkup and were more likely to be able to afford health care than uninsured individuals. Implementation of the PPACA was associated with increased health insurance coverage for 19- to 25-year-olds without significant changes in perceived health care affordability or health status. Although the likelihood of having a usual source of care declined between 2009 and 2012 for all, this decrease was smaller among 19- to 25-year-olds, and younger adults were more likely than 26- to 34-year-olds to have a usual source of care.

Virtual Simulated Care Coordination Rounds for Nursing Students.

PubMed

Badowski, Donna M

Implementation of the Affordable Care Act has nursing education reflecting on paradigm shifts in order to prepare nursing students for the evolving health care environment. The traditional focus of nursing education on nursing care in acute care settings does not provide learning experiences in care coordination and transitional care management skills. Virtual simulated care coordination rounds, using the National League for Nursing Advancing Care Excellence resources, offer nursing students an innovative experience in care coordination and transition care management.

76 FR 43237 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... General OMB Office of Management and Budget PHS Act Public Health Service Act QHP Qualified Health Plan...) performs some of the issuer's management functions under contract or delegation. Thus, CMS would permit a... billing, and case management from a health insurance issuer that existed on July 16, 2009, as long as the...

45 CFR 156.250 - Health plan applications and notices.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health plan applications and notices. 156.250 Section 156.250 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS...

45 CFR 156.250 - Health plan applications and notices.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health plan applications and notices. 156.250 Section 156.250 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS...

Creating a Customer-Centric Experience in Health.

PubMed

Rosenberg, Linda

2015-07-01

The Affordable Care Act means behavioral health will become part of "mainstream" health care. Here are three ways we can offer our expertise to support primary health providers in integrating behavioral health and three ways we can improve and better serve individuals as we move into the mainstream.

45 CFR 153.200 - [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false [Reserved] 153.200 Section 153.200 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

45 CFR 153.300 - [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false [Reserved] 153.300 Section 153.300 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

45 CFR 153.20 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Definitions. 153.20 Section 153.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT General Provisions § 153.20...

45 CFR 153.200 - [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false [Reserved] 153.200 Section 153.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

45 CFR 153.20 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Definitions. 153.20 Section 153.20 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT General Provisions § 153.20...

45 CFR 153.200 - [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false [Reserved] 153.200 Section 153.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

45 CFR 153.300 - [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false [Reserved] 153.300 Section 153.300 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

45 CFR 153.300 - [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false [Reserved] 153.300 Section 153.300 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

45 CFR 153.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Definitions. 153.20 Section 153.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT General Provisions § 153.20...

75 FR 57034 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed Information Collection Activity; Comment Request Proposed Projects Title: State Personal Responsibility Education Program (PREP). OMB No.: 0970-0380. Description: The Patient Protection and Affordable Care Act, 2010, also known as health care reform, amends...

78 FR 39297 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed Information Collection Activity; Comment Request Proposed Projects Title: State Personal Responsibility Education Program (PREP). OMB No.: 0970-0380. Description: The Patient Protection and Affordable Care Act, 2010, also known as health care reform, amends...

45 CFR 156.1120 - Quality rating system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Quality rating system. 156.1120 Section 156.1120 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Quality...

45 CFR 156.715 - Compliance reviews of QHP issuers in Federally-facilitated Exchanges.

Code of Federal Regulations, 2014 CFR

2014-10-01

...'s enrollees; (2) The QHP issuer's policies and procedures, protocols, standard operating procedures... REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Oversight and Financial Integrity Standards for Issuers of...

45 CFR 155.400 - Enrollment of qualified individuals into QHPs.

Code of Federal Regulations, 2012 CFR

2012-10-01

....400 Section 155.400 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.400...

45 CFR 153.540 - Compliance with risk corridors standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 153.540 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153.540 Compliance...

45 CFR 155.720 - Enrollment of employees into QHPs under SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

....720 Section 155.720 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.720 Enrollment of employees...

45 CFR 155.720 - Enrollment of employees into QHPs under SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

....720 Section 155.720 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.720 Enrollment of employees...

45 CFR 156.1250 - Acceptance of certain third party payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

....1250 Section 156.1250 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1250 Acceptance of certain third...

45 CFR 156.250 - Health plan applications and notices.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Health plan applications and notices. 156.250 Section 156.250 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS...

45 CFR 155.410 - Initial and annual open enrollment periods.

Code of Federal Regulations, 2012 CFR

2012-10-01

....410 Section 155.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.410...

45 CFR 155.1020 - QHP issuer rate and benefit information.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 155.1020 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Certification of Qualified Health Plans § 155.1020 QHP issuer rate and benefit...

45 CFR 155.400 - Enrollment of qualified individuals into QHPs.

Code of Federal Regulations, 2013 CFR

2013-10-01

....400 Section 155.400 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.400...

45 CFR 155.700 - Standards for the establishment of a SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 155.700 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.700 Standards for the establishment...

45 CFR 156.100 - State selection of benchmark.

Code of Federal Regulations, 2014 CFR

2014-10-01

....100 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.100 State selection of benchmark. Each State may identify a single...

45 CFR 155.700 - Standards for the establishment of a SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 155.700 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.700 Standards for the establishment...

45 CFR 155.410 - Initial and annual open enrollment periods.

Code of Federal Regulations, 2013 CFR

2013-10-01

....410 Section 155.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.410...

45 CFR 156.100 - State selection of benchmark.

Code of Federal Regulations, 2013 CFR

2013-10-01

....100 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.100 State selection of benchmark. Each State may identify a single...

Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services.

PubMed

Vujicic, Marko; Buchmueller, Thomas; Klein, Rachel

2016-12-01

The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services. We found that irrespective of age, income level, and type of insurance, more people reported financial barriers to receiving dental care, compared to any other type of health care. We discuss policy options to address financial barriers to dental care, particularly for adults. Project HOPE—The People-to-People Health Foundation, Inc.

Responding to the Affordable Care Act: a leadership opportunity for social workers in employee assistance programs.

PubMed

Frauenholtz, Susan

2014-08-01

Until recently, estimates indicated that more than half of Americans obtain health insurance through their employers. Yet the employer-based system leaves many vulnerable populations, such as low-wage and part-time workers, without coverage. The changes authorized by the Affordable Care Act (2010), and in particular the Health Insurance Marketplace (also known as health insurance exchanges), which became operational in 2014, are projected to have a substantial impact on the provision of employer-based health care coverage. Because health insurance is so intricately woven with employment, social workers in employee assistance programs (EAPs) are positioned to assume an active leadership role in guiding and developing the needed changes to employer-based health care that will occur as the result of health care reform. This article describes the key features and functions of the Health Insurance Marketplace and proposes an innovative role for EAP social workers in implementing the exchanges within their respective workplaces and communities. How EAP social workers can act as educators, advocates, and brokers of the exchanges, and the challenges they may face in their new roles, are discussed, and the next steps EAP social workers can take to prepare for health reform-related workplace changes are delineated.

What Can Massachusetts Teach Us about National Health Insurance Reform?

ERIC Educational Resources Information Center

Couch, Kenneth A., Ed.; Joyce, Theodore J., Ed.

2011-01-01

The Patient Protection and Affordable Care Act (PPACA) is the most significant health policy legislation since Medicare in 1965. The need to address rising health care costs and the lack of health insurance coverage is widely accepted. Health care spending is approaching 17 percent of gross domestic product and yet 45 million Americans remain…

What's at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care.

PubMed

Rambur, Betty A

2017-05-01

The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to "repeal and replace on day one"; Republican congressional leaders' more temperate suggestions in the first weeks of the Trump administration to "repair" the Affordable Care Act (ACA); and President Trump's February 5, 2017 statement-16 days after inauguration-that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven "volume to value" reimbursement changes. Moreover, popular and controversial elements of the ACA-for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision-are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses' capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.

Solidarity as a national health care strategy.

PubMed

West-Oram, Peter

2018-05-02

The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long-running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher-quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high-quality, affordable health care. © 2018 John Wiley & Sons Ltd.

American surgery and the Affordable Care Act.

PubMed

Stain, Steven C; Hoyt, David B; Hunter, John G; Joyce, Geoffrey; Hiatt, Jonathan R

2014-09-01

The Affordable Care Act (ACA) attempts to change the way we finance and deliver health care by coordinating the delivery of primary, specialty, and hospital services in accountable care organizations. The ways in which accountable care organizations will develop and evolve is unclear; however, the effects on surgeons and their patients will be substantial. High-value care in the ACA emphasizes quality, safety, resource use and appropriateness, and the patient's experience of care. Payment will be linked to these principles. Department chairs overseeing a clinical enterprise in academic medical centers now must add financial and quality measures to the traditional missions of education, research, and clinical service. At a time when surgical training is in dramatic evolution, with work hour limitations for residents and an emphasis on quality, productivity, and increasing oversight of trainees for faculty, residency programs will need to meet the increasing demands of an aging population and newly insured patients under the ACA. The American College of Surgeons, with its century-long commitment to quality improvement, research-based standards, and performance measurement and verification, has begun its Inspiring Quality Campaign, is developing new educational tools, and is preparing proposals for payment reform based on surgeons' participation in quality programs.

Amendments to excepted benefits. Final rules.

PubMed

2014-10-01

This document contains final regulations that amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code (the Code), and the Public Health Service Act. Excepted benefits are generally exempt from the health reform requirements that were added to those laws by the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act. In addition, eligibility for excepted benefits does not preclude an individual from eligibility for a premium tax credit under section 36B of the Code if an individual chooses to enroll in coverage under a Qualified Health Plan through an Affordable Insurance Exchange. These regulations finalize some but not all of the proposed rules with minor modifications; additional guidance on limited wraparound coverage is forthcoming.

The Role of Nutrition-Related Initiatives in Addressing Community Health Needs Assessments

ERIC Educational Resources Information Center

George, Daniel R.; Rovniak, Liza S.; Dillon, Judy; Snyder, Gail

2017-01-01

Academic Health Centers and nonprofit hospitals are exploring strategies to meet Affordable Care Act mandates requiring tax-exempt institutions to address community health needs, which commonly include major chronic illnesses. We explore the implications of this regulatory landscape, describing methods that nonprofit health care institutions are…

45 CFR 153.365 - General oversight requirements for State-operated risk adjustment programs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... risk adjustment programs. 153.365 Section 153.365 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program...

78 FR 7264 - Health Insurance Premium Tax Credit

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 9611] RIN 1545-BL49 Health.... SUMMARY: This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation...

78 FR 58311 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for OMB Review; Comment Request Title: State Personal Responsibility Education Program (PREP). OMB No.: 0970-0380. Description: The Patient Protection and Affordable Care Act, 2010, also known as health care reform, amended Title V of the Social Security...

75 FR 74055 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for OMB Review; Comment Request Title: State Personal Responsibility Education Program (PREP). OMB No.: 0970-0380. Description: The Patient Protection and Affordable Care Act, 2010, also known as health care reform, amends Title V of the Social Security...

45 CFR 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... cost-sharing reduction standards. 156.215 Section 156.215 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification...

45 CFR 156.105 - Determination of EHB for multi-state plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

....105 Section 156.105 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.105 Determination of EHB for multi-state...

45 CFR 156.330 - Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Health Plans in Federally-facilitated Exchanges. 156.330 Section 156.330 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Federally-Facilitated Exchange...

45 CFR 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... cost-sharing reduction standards. 156.215 Section 156.215 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification...

45 CFR 153.520 - Attribution and allocation of revenue and expense items.

Code of Federal Regulations, 2012 CFR

2012-10-01

... items. 153.520 Section 153.520 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153...

45 CFR 153.510 - Risk corridors establishment and payment methodology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... methodology. 153.510 Section 153.510 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153...

45 CFR 153.510 - Risk corridors establishment and payment methodology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... methodology. 153.510 Section 153.510 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153...

45 CFR 156.1210 - Confirmation of HHS payment and collections reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... reports. 156.1210 Section 156.1210 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1210 Confirmation of HHS...

45 CFR 153.520 - Attribution and allocation of revenue and expense items.

Code of Federal Regulations, 2014 CFR

2014-10-01

... items. 153.520 Section 153.520 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153...

45 CFR 153.520 - Attribution and allocation of revenue and expense items.

Code of Federal Regulations, 2013 CFR

2013-10-01

... items. 153.520 Section 153.520 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153...

45 CFR 155.415 - Allowing issuer application assisters to assist with eligibility applications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... with eligibility applications. 155.415 Section 155.415 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified...

45 CFR 156.105 - Determination of EHB for multi-state plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

....105 Section 156.105 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.105 Determination of EHB for multi-state...

Changes in Young Adult Primary Care Under the Affordable Care Act

PubMed Central

Ford, Carol A.; French, Benjamin; Rubin, David M.

2015-01-01

Objectives. We sought to describe changes in young adults’ routine care and usual sources of care (USCs), according to provider specialty, after implementation of extended dependent coverage under the Affordable Care Act (ACA) in 2010. Methods. We used Medical Expenditure Panel Survey data from 2006 to 2012 to examine young adults’ receipt of routine care in the preceding year, identification of a USC, and USC provider specialties (pediatrics, family medicine, internal medicine, and obstetrics and gynecology). Results. The percentage of young adults who sought routine care increased from 42.4% in 2006 to 49.5% in 2012 (P < .001). The percentage identifying a USC remained stable at approximately 60%. Among young adults with a USC, there was a trend between 2006 and 2012 toward increasing percentages with pediatric (7.6% vs 9.1%) and family medicine (75.9% vs 80.9%) providers and declining percentages with internal medicine (11.5% vs 7.6%) and obstetrics and gynecology (5.0% vs 2.5%) providers. Conclusions. Efforts under the ACA to increase health insurance coverage had favorable effects on young adults’ use of routine care. Monitoring routine care use and USC choices in this group can inform primary care workforce needs and graduate medical education priorities across specialties. PMID:26447914

Health-care reform's great expectations and physician reality.

PubMed

Van Mol, Andre

2010-09-01

The Patient Protection and Affordable Care Act will not prove to be the reform for which physicians were long hoping. Private insurance rates will climb sharply, forcing people onto government programs; physician reimbursement will plummet; the physician shortage will worsen; rationing in the form of waiting lists is certain; health care as a whole will worsen; and once fully engaged, nationalization of health care will be irreversible.

Affordable Care for Women Act

THOMAS, 111th Congress

Sen. Boxer, Barbara [D-CA

2009-01-22

Senate - 01/22/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

78 FR 12833 - Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... in 2014, all non-grandfathered health insurance coverage in the individual and small group markets... PHS Act directs non-grandfathered group health plans to ensure that cost- sharing under the plan does... individual and small group markets, and not to Medicaid benchmark or benchmark-equivalent plans. In a...

77 FR 70643 - Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

... coverage \\1\\ in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans...) Act extends the coverage of the EHB package to issuers of non-grandfathered individual and small group... small group markets, and not to Medicaid benchmark or benchmark-equivalent plans. EHB applicability to...

75 FR 52760 - Medicare Program; Listening Session Regarding the Implementation of Section 10332 of the Patient...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... sources and types of other data that these organizations might match to Medicare claims; challenges in... and Affordable Care Act, Availability of Medicare Data for Performance Measurement DATE: September 20... 1874 of the Social Security Act: Availability of Medicare Data for Performance Measurement. The purpose...

76 FR 51201 - Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... standards, eligibility determination process, and applicant information verification process. a. Definitions... section 4(d) of the Indian Self-Determination and Education Assistance Act (ISDEAA) (Pub. L. 93-638, 88... attestation may be made by the applicant (self-attestation), an application filer, or in cases in which an...

78 FR 65045 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

.... Definitions (Sec. 144.103) B. Part 147--Health Insurance Reform Requirements for the Group and Individual... Risk Adjustment Methodology 5. Subpart E--Health Insurance Issuer and Group Health Plan Standards... (PHS Act) relating to health insurance issuers in the group and individual markets and to group health...

A bill to amend the Patient Protection and Affordable Care Act to apply the provisions of the Act to certain Congressional staff and members of the executive branch.

THOMAS, 113th Congress

Sen. Vitter, David [R-LA

2013-05-08

Senate - 05/08/2013 Read twice and referred to the Committee on Homeland Security and Governmental Affairs. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Patient Protection and Affordable Care Act of 2010: a primer for neurointerventionalists.

PubMed

Manchikanti, Laxmaiah; Hirsch, Joshua A

2012-03-01

The Patient Protection and Affordable Care Act (the ACA, for short) became law on 23 March 2010. It represents the most significant transformation of the American healthcare system since Medicare and Medicaid. Essentials of ACA include: (1) a mandate for individuals and businesses requiring as a matter of law that nearly every American has an approved level of health insurance or pay a penalty; (2) a system of federal subsidies to completely or partially pay for the now required health insurance for ∼34 million Americans who are currently uninsured-subsidized through Medicaid and Exchanges; (3) extensive new requirements on the health insurance industry and (4) changes in the practice of medicine. The Act is divided into 10 titles. It contains provisions that went into effect starting on 21 June 2010 with many of the provisions going into effect in 2014 and later. The ACA goes well beyond insurance and payment reform. Practicing physicians will potentially be impacted by the Independent Payment Advisory Board and the Patient Centered Outcomes Research Institute.

The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations

PubMed Central

Kominski, Gerald F.; Nonzee, Narissa J.; Sorensen, Andrea

2018-01-01

The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law’s impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations. PMID:27992730

45 CFR 156.20 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Affordable Care Act; and (3) A bronze, silver, gold, or platinum level of coverage as described in section....103 of this subtitle. Level of coverage means one of four standardized actuarial values as defined by...

77 FR 48922 - Regulations Pertaining to the Disclosure of Return Information To Carry Out Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-15

... Health Insurance Affordability Programs; Hearing Cancellation AGENCY: Internal Revenue Service (IRS... Health Care and Education Reconciliation Act of 2010. DATES: The public hearing, originally scheduled for...

38 CFR 18a.3 - Delegation to the Chief Medical Director.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Act of 1964, in connection with payments to State homes, with State home facilities for furnishing nursing home care, and from recognized national organizations whose representatives are afforded space and...

76 FR 59702 - Notice of Intent To Award Affordable Care Act (ACA) Funding

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative..., deliver, and evaluate core competency-based training and education that target the public health workforce...

78 FR 42823 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-17

...This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the Affordable Care Act; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. The final rule also directs that each Exchange designate organizations which will then certify their staff members and volunteers to be application counselors that assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs, and provides standards for that designation.

Participatory Evaluation of a Community Mobilization Effort to Enroll Wyandotte County, Kansas, Residents Through the Affordable Care Act

PubMed Central

Sepers, Charles E.; McKain, Wesley

2015-01-01

Successful implementation of the Affordable Care Act (ACA) depends on the capacity of local communities to mobilize for action. Yet the literature offers few systematic investigations of what communities are doing to ensure support for enrollment. In this empirical case study, we report implementation and outcomes of Enroll Wyandotte, a community mobilization effort to facilitate enrollment through the ACA in Wyandotte County, Kansas. We describe mobilization activities during the first round of open enrollment in coverage under the ACA (October 1, 2013–March 31, 2014), including the unfolding of community and organizational changes (e.g., new enrollment sites) and services provided to assist enrollment over time. The findings show an association between implementation measures and newly created accounts under the ACA (the primary outcome). PMID:25905820

Medicaid and Children's Health Insurance Programs: Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Other Provisions Related to Eligibility and Enrollment for Medicaid and CHIP. Final rule.

PubMed

2016-11-30

This final rule implements provisions of the Affordable Care Act that expand access to health coverage through improvements in Medicaid and coordination between Medicaid, CHIP, and Exchanges. This rule finalizes most of the remaining provisions from the "Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing; Proposed Rule" that we published in the January 22, 2013, Federal Register. This final rule continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the Affordable Care Act.

Incentivizing shared decision making in the USA--where are we now?

PubMed

Durand, Marie-Anne; Barr, Paul J; Walsh, Thom; Elwyn, Glyn

2015-06-01

The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision making and the use of patient decision aids would be measured. Our goal was to review developments and proposals put forward. We performed a qualitative document analysis following a pragmatic search of Medline, Google, Google Scholar, Business Source Complete (Ebscohost), and LexisNexis from 2009-2013 using the following key words: "Patient Protection and Affordable Care Act", "Decision Making", "Affordable Care Act", "Shared Decision Making", "measurement", "incentives", and "payment." We observed a lack of clarity about how to measure shared decision making, about how best to reward the use of patient decisions aids, and therefore how best to incentivize the process. Many documents clearly imply that providing and disseminating patient decision aids might be equivalent to shared decision making. However, there is little evidence that these tools, when used by patients in advance of clinical encounters, lead to significant change in patient-provider communication. The assessment of shared decision making for performance management remains challenging. Efforts to incentivize shared decision making are at risk of being limited to the promotion of patient decision aids, passing over the opportunity to influence the communication processes between patients and providers. Copyright © 2014 Elsevier Inc. All rights reserved.

Evolution of US Health Care Reform.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2017-03-01

Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

Opportunities and Threats for College Women's Health: Health Care Reform and Higher Education

ERIC Educational Resources Information Center

Yakaboski, Tamara; Hunter, Liz; Manning-Ouellette, Amber

2014-01-01

The Patient Protection and Affordable Care Act (PPACA) of 2010 (P.L. 118-148) has already changed college students' health care options and has a larger impact on women as they outnumber men in college enrollment and require unique services. Through a feminist policy framework, we discuss how the PPACA impacts college women's health and…

Is Value-Driven Health Care an Unfunded Mandate for Radiologists?

PubMed

McGinty, Geraldine

2016-02-01

The goals of the 2010 Patient Protection and Affordable Care Act (ACA) can be summed up by the Triple Aim, as defined by the Institute for Healthcare Improvement: Improve population health, optimize the patient experience, and reduce the costs of care. Despite recent reimbursement reductions, radiologists have increasing opportunities to participate in value-based payment programs and should leverage those opportunities.

Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature.

PubMed

Ostermayer, Daniel G; Brown, Charles A; Fernandez, William G; Couvillon, Emily

2017-04-01

This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act (ACA) as it relates to emergency medical services (EMS) in order to provide guidance for navigating current and future healthcare changes. We conducted a comprehensive review to identify all existing literature related to the ACA and EMS and all sections within the federal law pertaining to EMS. Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems. New Medicaid enrollees and changes to existing coverage plans may alter EMS transport volumes. Reimbursement changes such as adjustments to the ambulance inflation factor (AIF) alter the yearly increases in EMS reimbursement by incorporating the multifactor productivity value into yearly reimbursement adjustments. New initiatives, funded by the Center for Medicare & Medicaid Innovation are exploring novel and cost-effective prehospital care delivery opportunities while EMS agencies individually explore partnerships with healthcare systems. EMS systems should be aware of the direct and indirect impact of ACA on prehospital care due to the potential for changes in financial reimbursement, acuity and volume changes, and ongoing new care delivery initiatives.

Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature

PubMed Central

Ostermayer, Daniel G.; Brown, Charles A.; Fernandez, William G.; Couvillon, Emily

2017-01-01

Introduction This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act (ACA) as it relates to emergency medical services (EMS) in order to provide guidance for navigating current and future healthcare changes. Methods We conducted a comprehensive review to identify all existing literature related to the ACA and EMS and all sections within the federal law pertaining to EMS. Results Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems. New Medicaid enrollees and changes to existing coverage plans may alter EMS transport volumes. Reimbursement changes such as adjustments to the ambulance inflation factor (AIF) alter the yearly increases in EMS reimbursement by incorporating the multifactor productivity value into yearly reimbursement adjustments. New initiatives, funded by the Center for Medicare & Medicaid Innovation are exploring novel and cost-effective prehospital care delivery opportunities while EMS agencies individually explore partnerships with healthcare systems. Conclusion EMS systems should be aware of the direct and indirect impact of ACA on prehospital care due to the potential for changes in financial reimbursement, acuity and volume changes, and ongoing new care delivery initiatives. PMID:28435495

The Patient Protection and Affordable Care Act: the victory of unorthodox lawmaking.

PubMed

Beaussier, Anne-Laure

2012-10-01

The 2010 Patient Protection and Affordable Care Act was a major legislative achievement of the 111th Congress. This law structurally reforms the US health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at the process for reform, what strikes an observer of US health care policy in the first place is that the Democratic majority was able to enact something in a political field characterized by strong resistance to change. This article builds on that observation. Arguments concentrate on the legislative process of the reform and support the idea that it may be partly explained by considering an evolution of US legislative institutions, mostly in the sense of a more centralized legislative process. Based on approximately one hundred semidirected interviews, I argue that the Democratic majority, building on lessons from both President Bill Clinton's health care reform attempt and the Republicans' strategy of using strong congressional leadership to pass social reforms, was able to overcome institutional constraints that have long prevented comprehensive change. A more centralized legislative process, which has been described as "unorthodox lawmaking," enabled the Democratic leadership to overcome multiple institutional and political veto players.

Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.

PubMed

Dobson, Allen; DaVanzo, Joan E; Haught, Randy; Phap-Hoa, Luu

2017-11-01

Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.

Attitudes About and Practices of Health Promotion and Prevention Among Primary Care Providers.

PubMed

Luquis, Raffy R; Paz, Harold L

2015-09-01

The Patient Protection and Affordable Care Act's emphasis on health promotion and prevention activities required an examination of the current practices of primary care providers in these areas. A total of 196 primary care providers completed a survey to assess current health promotion and prevention attitudes, practices, and barriers. Results of this study showed that family physicians in Pennsylvania recognize the importance of and their role in providing health promotion and prevention and offer advice in key behavioral and disease prevention areas. Results from the study suggest that their ability to provide these services is hindered by a lack of time and the heavy workload. Although most family physicians provided advice to patients in several health promotion and prevention areas, few participants reported that they referred patients to other health professionals. Finally, when it comes to preventive services, participants ranked blood pressure screening, tobacco use screening, and tobacco use cessation interventions as the most important services. Effective implementation of the Patient Protection and Affordable Care Act will require necessary resources and support of primary care providers to help patients achieve healthier lives. © 2014 Society for Public Health Education.

The CLASS Act: is it dead or just sleeping?

PubMed

Wiener, Joshua M

2012-01-01

The Affordable Care Act (ACA) established a voluntary public insurance program for long-term care: the Community Living Assistance Services and Supports (CLASS) Act. In October 2011, the Obama Administration announced that the program would not be implemented because of the high risk of fiscal insolvency. Under the legislative design, adverse selection was a major risk and premiums would have been very high. This article discusses several CLASS Act design and implementation issues, including the design features that led to the decision not to implement the program: the voluntary enrollment, the weak work requirement, the lifetime and cash benefits, and the premium subsidy for low-income workers and students.

How Will the Affordable Care Act's Cost-Sharing Reductions Affect Consumers' Out-of-Pocket Costs in 2016?

PubMed

Collins, Sara R; Gunja, Munira; Beutel, Sophie

2016-03-01

Health insurers selling plans in the Affordable Care Act's market­places are required to reduce cost-sharing in silver plans for low- and moderate-income people earning between 100 percent and 250 percent of the federal pov­erty level. In 2016, as many as 7 million Americans may have plans with these cost-sharing reductions. In the largest markets in the 38 states using the federal website for marketplace enrollment, the cost-sharing reductions substantially lower projected out-of-pocket costs for people who qualify for them. However, the degree to which consumers' out-of-pocket spending will fall varies by plan and how much health care they use. This is because insurers use deductibles, out-of-pocket limits, and copayments in different combinations to lower cost-sharing for eligible enrollees. In 2017, marketplace insurers will have the option of offering standard plans, which may help simplify consumers' choices and lead to more equal cost-sharing.

75 FR 70371 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the ``skilled services'' section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.

Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care.

PubMed

Graves, John A; Swartz, Katherine

The aim of this study was to inform oncologists about how repealing the Affordable Care Act (ACA) may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments. We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries' access to cancer treatments. Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials. Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance-not only the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage.

Support for Government Provision of Health Care and the Patient Protection and Affordable Care Act

PubMed Central

Corman, Juliane; Levin, David

2016-01-01

Since the 1930s, US politicians have argued about whether healthcare should be the responsibility of the federal government. Both major political parties have cited public opinion concerning Americans’ support for or rejection of government provision of healthcare to support their position. With the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, however, the political debate has changed. Where it had been about the government provision of healthcare as an abstract principle, it became a debate imbued with evaluations of the implementation of the ACA itself. This spawned a new line of research examining the consequences of the ACA’s implementation on public attitudes toward government provision of healthcare. The change in support for government provision of healthcare and the new post-ACA research highlight a need for a long-term examination of trends in support over the past two decades that will provide context for the new studies. This study provides that examination. PMID:27257309

Small firm self-insurance under the Affordable Care Act.

PubMed

Buettgens, Matthew; Blumberg, Linda J

2012-11-01

The Affordable Care Act changes the small-group insurance market substan­tially beginning in 2014, but most changes do not apply to self-insured plans. This exemp­tion provides an opening for small employers with healthier workers to avoid broader sharing of health care risk, isolating higher-cost groups in the fully insured market. Private stop-loss or reinsurance plans can mediate the risk of self-insurance for small employ­ers, facilitating the decision to self-insure. We simulate small-employer coverage decisions under the law and find that low-risk stop-loss policies lead to higher premiums in the fully insured small-group market. Average single premiums would be up to 25 percent higher, if stop-loss insurance with no additional risk to employers than fully insuring is allowed--an option available in most states absent further government action. Regulation of stop-loss at the federal or state level can, however, prevent such adverse selection and increase stabil­ity in small-group insurance coverage.

The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform.

PubMed

Larkin, D Justin; Swanson, R Chad; Fuller, Spencer; Cortese, Denis A

2016-02-01

The current health system in the United States is the result of a history of patchwork policy decisions and cultural assumptions that have led to persistent contradictions in practice, gaps in coverage, unsustainable costs, and inconsistent outcomes. In working toward a more efficient health system, understanding and applying complexity science concepts will allow for policy that better promotes desired outcomes and minimizes the effects of unintended consequences. This paper will consider three applied complexity science concepts in the context of the Patient Protection and Affordable Care Act (PPACA): developing a shared vision around reimbursement for value, creating an environment for emergence through simple rules, and embracing transformational leadership at all levels. Transforming the US health system, or any other health system, will be neither easy nor quick. Applying complexity concepts to health reform efforts, however, will facilitate long-term change in all levels, leading to health systems that are more effective, efficient, and equitable. © 2014 John Wiley & Sons, Ltd.

Lost in the Health Care Reform Discussion: Health Care as a Right or Privilege

ERIC Educational Resources Information Center

O'Rourke, Thomas W.

2017-01-01

Health care has been an ongoing issue of public concern for decades, well before President Obama took office. Passage of the Affordable Care Act (ACA), also known as Obamacare, in March 2010 and upheld by a Supreme Court in June 2012. With Republicans now in control of both the House and Senate as well as the presidency, the ACA in its current…

Limited Impact on Health and Access to Care for 19- to 25-Year-Olds Following the Patient Protection and Affordable Care Act

PubMed Central

Kotagal, Meera; Carle, Adam C.; Kessler, Larry G.; Flum, David R.

2014-01-01

IMPORTANCE The Patient Protection and Affordable Care Act (PPACA) allowed young adults to remain on their parents’ insurance until 26 years of age. Reports indicate that this has expanded health coverage. OBJECTIVE To evaluate coverage, access to care, and health care use among 19- to 25-year-olds compared with 26- to 34-year-olds following PPACA implementation. DESIGN, SETTING, AND PARTICIPANTS Data from the Behavior Risk Factor Surveillance System and the National Health Interview Survey, which provide nationally representative measures of coverage, access to care, and health care use, were used to conduct the study among participants aged 19 to 25 years (young adults) and 26 to 34 years (adults) in 2009 and 2012. EXPOSURE Self-reported health insurance coverage. MAIN OUTCOMES AND MEASURES Health status, presence of a usual source of care, and ability to afford medications, dental care, or physician visits. RESULTS Health coverage increased between 2009 and 2012 for 19- to 25-year-olds (68.3% to 71.7%). Using a difference-in-differences (DID) approach, after adjustment, the likelihood of having a usual source of care decreased in both groups but more significantly for 26- to 34-year-olds (DID, 2.8%; 95% CI, 0.45 to 5.15). There was no significant change in health status for 19- to 25-year-olds compared with 26- to 34-year-olds (DID, −0.5%; 95% CI, −1.87 to 0.87). There was no significant change for 19- to 25-year-olds compared with 26- to 34-year-olds in the percentage who reported receiving a routine checkup in the past year (DID, 0.3%; 95% CI, −2.25 to 2.85) or in the ability to afford prescription medications (DID, −0.4%; 95% CI, −2.93 to 1.93), dental care (DID, −2.6%; 95% CI, −5.61 to 0.61), or physician visits (DID, −1.7%; 95% CI, −3.66 to 0.26). There was also no change in the percentage who reported receiving a flu shot (DID, 1.9; 95% CI, −1.93 to 4.93). Insured individuals were more likely to report having a usual source of care and a recent routine checkup and were more likely to be able to afford health care than uninsured individuals. CONCLUSIONS AND RELEVANCE Implementation of the PPACA was associated with increased health insurance coverage for 19- to 25-year-olds without significant changes in perceived health care affordability or health status. Although the likelihood of having a usual source of care declined between 2009 and 2012 for all, this decrease was smaller among 19- to 25-year-olds, and younger adults were more likely than 26- to 34-year-olds to have a usual source of care. PMID:25200181

Healthcare.gov: Opportunity out of Disaster. Teaching Case

ERIC Educational Resources Information Center

Cundiff, Jacob; McCallum, Taylor; Rich, Andrew; Truax, Michael; Ward, Tamara; Havelka, Douglas

2015-01-01

The launch of HealthCare.gov, the website of the Affordable Care Act (AKA Obamacare), was a major public relations disaster for the Obama administration. This case examines some of the factors that contributed to the failure of the launch and then details how Optum, an information technology service provider, considered the opportunity provided by…

Workforce strategies to improve children's oral health.

PubMed

Goodwin, Kristine

2014-12-01

(1) Tooth decay is the most common chronic disease for children. (2) As millions receive dental coverage under the Affordable Care Act, the demand for dental services is expected to strain the current workforce's ability to meet their needs. (3) States have adopted various workforce approaches to improve access to dental care for underserved populations.

Finding What Works: Leadership Competencies for the Changing Healthcare Environment

ERIC Educational Resources Information Center

Herd, Ann M.; Adams-Pope, Brittany L.; Bowers, Amanda; Sims, Brittany

2016-01-01

As the world of healthcare changes rapidly, healthcare leaders and managers must hone their leadership competencies in order to remain effective in their organizations. With changes such as the Affordable Care Act, increasing medical school costs, decreased graduation rates, and increased needs for care, how are current and future healthcare…

45 CFR 156.298 - Meaningful difference standard for Qualified Health Plans in the Federally-facilitated Exchanges.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Health Plans in the Federally-facilitated Exchanges. 156.298 Section 156.298 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum...

45 CFR 156.1230 - Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.

Code of Federal Regulations, 2014 CFR

2014-10-01

... considered to be through the Exchange. 156.1230 Section 156.1230 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities...

45 CFR 156.120 - Collection of data from certain issuers to define essential health benefits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... essential health benefits. 156.120 Section 156.120 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Standards for Essential Health Benefits, Actuarial Value, and Cost...

45 CFR 156.1230 - Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.

Code of Federal Regulations, 2013 CFR

2013-10-01

... considered to be through the Exchange. 156.1230 Section 156.1230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities...

Treatment of Febrile illness with artemisinin combination therapy: prevalence and predictors in five African household surveys.

PubMed

Vialle-Valentin, Catherine E; LeCates, Robert F; Zhang, Fang; Ross-Degnan, Dennis

2015-01-01

To evaluate the determinants of compliance with national policies recommending Artemisinin Combination Therapy (ACT) for the treatment of uncomplicated malaria in the community. We used data from Gambia, Ghana, Kenya, Nigeria, and Uganda national household surveys that were conducted with a standardized World Health Organization (WHO) methodology to measure access to and use of medicines. We analyzed all episodes of acute fever reported in the five surveys. We used logistic regression models accounting for the clustered design of the surveys to identify determinants of seeking care in public healthcare facilities, of being treated with antimalarials, and of receiving ACT. Overall, 92% of individuals with a febrile episode sought care outside the home, 96% received medicines, 67% were treated with antimalarials, and 16% received ACT. The choice of provider was influenced by perceptions about medicines availability and affordability. In addition, seeking care in a public healthcare facility was the single most important predictor of treatment with ACT [odds ratio (OR): 4.64, 95% confidence intervals (CI): 2.98-7.22, P < 0.001]. Children under 5 years old were more likely than adults to be treated with antimalarials [OR: 1.28, CI: 0.91-1.79, not significant (NS)] but less likely to receive ACT (OR: 0.80, CI: 0.57-1.13, NS). Our results confirm the high prevalence of presumptive antimalarial treatment for acute fever, especially in public healthcare facilities where poor people seek care. They show that perceptions about access to medicines shape behaviors by directing patients and caregivers to sources of care where they believe medicines are accessible. The success of national policies recommending ACT for the treatment of uncomplicated malaria depends not only on restricting ACT to confirmed malaria cases, but also on ensuring that ACT is available and affordable for those who need it.

Dental plan premiums in the Affordable Care Act marketplaces trended downward from 2014 through 2016.

PubMed

Nasseh, Kamyar; Vujicic, Marko

2017-04-01

Pediatric dental benefits must be offered in the health insurance marketplaces created under the Affordable Care Act. The authors analyzed trends over time in premiums and the number of dental insurers participating in the marketplaces. The authors collected dental benefit plan data from 35 states participating in the federally facilitated marketplaces in 2014, 2015, and 2016. For each county, they counted the number of issuers offering stand-alone dental plans (SADPs) and medical plans with embedded pediatric dental benefits. They also analyzed trends in premiums. From 2014 through 2016, the number of issuers of stand-alone dental plans and medical plans with embedded pediatric dental benefits either did not change or increased in most counties. Average premiums for low-actuarial-value SADPs declined from 2014 through 2016. The increase in the number of issuers of stand-alone dental plans and medical plans with embedded dental benefits may be associated with lower premiums. However, more research is needed to determine if this is the case. Affordable dental plans in the marketplaces could induce people with lower incomes to sign up for dental benefits. Newly insured people could have significant oral health needs and pent-up demand for dental care. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

Critical Anthropology of Global Health "takes a stand" statement: a critical medical anthropological approach to the U.S.'s Affordable Care Act.

PubMed

Horton, Sarah; Abadía, Cesar; Mulligan, Jessica; Thompson, Jennifer Jo

2014-03-01

The Affordable Care Act (ACA) of 2010--the U.S.'s first major health care reform in over half a century-has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government-funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer-based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on-the-ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of "cost" and "profit" that underpin the global spread of market-based medicine more broadly. © 2014 by the American Anthropological Association.

Freedom of conscience and health care in the United States of america: the conflict between public health and religious liberty in the patient protection and affordable care act.

PubMed

West-Oram, Peter

2013-09-01

The recent confirmation of the constitutionality of the Obama administration's Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties.

77 FR 38042 - TRICARE; Implementation of TRICARE Transitional Outpatient Payments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... amounts using a method similar to Medicare. TRICARE will pay an amount equal to 85 percent of the... TRICARE TOPs provision. The Patient Protection and Affordable Care Act (PPACA) extended the hold harmless...

77 FR 35981 - Notice of Intent To Award Affordable Care Act (ACA) Funding, HM10-1001

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... health screenings, such as the Community Transformation Grant Program, the Education and Outreach... communication and education activities designed to raise awareness among public health laboratories about the...

76 FR 41261 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1003

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. The ACA...

76 FR 54773 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. REACH...

Shared responsibility payment for not maintaining minimum essential coverage. Final regulations.

PubMed

2013-08-30

This document contains final regulations on the requirement to maintain minimum essential coverage enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the TRICARE Affirmation Act and Public Law 111-173. These final regulations provide guidance to individual taxpayers on the liability under section 5000A of the Internal Revenue Code for the shared responsibility payment for not maintaining minimum essential coverage and largely finalize the rules in the notice of proposed rulemaking published in the Federal Register on February 1, 2013.

The availability of community health center services and access to medical care.

PubMed

Kirby, James B; Sharma, Ravi

2017-12-01

Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period. We pooled six years of data from the Medical Expenditure Panel Survey (2008-2013) and linked it to geographic data on CHCs from Health Resources and Services Administration's Health Center Program Uniform Data System. We also link other community characteristics from the Area Health Resource File and the Dartmouth Institute's data files. The associations between CHC availability and our access measures are estimated with logistic regression models stratified by insurance status. The availability of CHC services was positively associated with both measures of access among those with no insurance coverage. Additionally, it was positively associated with having a usual source of care among those with Medicaid and private insurance. These findings persist after controlling for key individual- and community-level characteristics. Our findings suggest that an enhanced CHC program could be an important resource for supporting the efficacy of expanded Medicaid coverage under the Affordable Care Act and, ultimately, improving access to quality primary care for underserved Americans. Published by Elsevier Inc.

Nurses take center stage in private duty home care.

PubMed

Brackett, Nicole

2013-06-01

The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care.

What It Means: TMA Analyzes Pros and Cons of Health System Reform Law.

PubMed

Ortolon, Ken

2010-05-01

Congressional passage of the health system reform bill, the Patient Protection and Affordable Care Act, sent physicians and patients scrambling to examine the fine print to determine how the new law will impact health care for all Americans. TMA launched a massive new education campaign to help Texas physicians and their practices survive and thrive in the new health care environment.