APPENDIX A: Title I (Individual & Group Market Reforms) PPACA Codification Adds section 2711 to the Public Health

Services Act Adds section 2712 to the Public Health Services Act Description Insurers cannot have lifetime limits on the amount of care customers can get and can't have yearly limits either. Effective Date 2010

1001

1001

No more "rescissions." Insurers cannot drop customers once they get sick. The only time they can drop a customer is if that customer commits fraud. Insurance plans need to include preventive care (colonoscopies, mammograms, immunizations, etc.) without any extra costs (like co-pays). I should note that this section also includes something that led to a bit of controversy - It says that health insurance must include preventive care for women supported by the Health Resources and Services Administration. And the Health Resources and Services Administration, on the recommendation of the independent Institute of Medicine of the National Academy of Science, has determined that preventive care for women should include access to, amongst other things, contraception. Insurers must provide these services, and cannot require a co-pay for them. Insurance plans need to cover dependents up to the age of 26. Insurers and plan sponsors of self-funded plans must provide summary of benefits to all participants and applicants, based on format set by Secretary, using uniform definitions and stating whether the plan provides minimum essential coverage and whether ensures the plan's share of costs is at least 60% of actuarial value. Adds that "except that a plan or coverage that is not offered through an Exchange shall only be required to submit the information required to the Secretary and the State insurance commissioner and make such information available to the public" under section 1311(e)(3). Group health plans ("other than a self-insured plan") must abide by section 105(h)(2) of IRC prohibition on discrimination in favor of highly compensated individuals.

2010

1001

Adds section 2713 to the Public Health Services Act

2010

1001

Adds section 2714 to the Public Health Services Act Adds section 2715 to the Public Health Services Act Adds section 2715A to the Public Health Services Act Adds section 2716 to the Public Health Services Act

2010

1001

2012

10101 RECON

10101 RECON

1001 + 10101 RECON

Adds section 2718 to the Public Health Services Act Adds section 2719 to the Public Health Services Act Adds section 2719A to the Public Health Services Act Adds section 2793 to the Public Health Services Act

Insurance companies need to make public how much they spend on insurance claims, and what they make in profits. Starting in 2011, if their costs (and risks, and overhead, etc.) is less than 80-85% of the money they make, they need to send rebates out to their customers. Insurers need to offer customers the ability to appeal a claim that was denied. This appeal process will be monitored under an external review process to make sure it's doing what it's supposed to. Makes sure that insured customers can decide their own OB/GYN and Pediatrician as Primary Care Provider, and that if their insurance covers emergency care, customers can go to any emergency room without having to worry whether their insurance will cover that specific emergency room. The Secretary of HHS will offer grants to states so that the states can have a Consumer Service programs that will investigate problems customers have with insurance, help to spread information, answer questions, and help to facilitate appeals processes. The Secretary of HHS will decide what constitutes an "unreasonable" increase in premiums, and conduct an annual review of increases in premiums to look for these. Insurers must explain their reasons for any such unreasonable increases before making them, and must make this information available to the public. If any insurer increases premiums too much or too fast, it may be dropped from "exchange" programs. The Secretary of HHS will make a temporary "high-risk pool" insurance program for people with pre-existing conditions, to make sure they can get insurance right now. Establish for establishment of another temporary program to reimbursement plans for certain retiree coverage for retirees who are between 55 and 65 and who are not Medicare-eligible. It would pay 80 percent of claims between $15,000 and $90,000. Reimbursement must be used to reduce costs, premium or cost-sharing of plan participants.

2011

1001

2010

1001 + 10101 RECON

2010

1002

2010

1003

Adds section 2794 to the Public Health Services Act

2010

1101

20102014

1102

20102014

1103

Amends the Public Health Services Act

Create a website to help people find health insurance in their state, and give them information about options available to them. (http://www.healthcare.gov/) New "administrative simplification" standards for the electronic exchange of information to simplify and reduce the paperwork and clerical burden on patients, providers, and insurers.

2010

1104 Adds section 2704 to the Public Health Services Act

2013

1201

No more turning people down due to "pre-existing conditions". This is already in effect (as of 6 months after this bill passed) for anyone under the age of 19.

2010

1201 + 10103 RECON

Adds section 2701 to the Public Health Services Act

The only things about you that insurers can take into consideration when determining your premium rates are whether you want to cover your family or just you, what your age is, whether or not you use tobacco, and other factors to be determined by each state (unless the Secretary of HHS believes a state's "rating area" to be inadequate, in which that rating area may be changed). Amended to insert "(other than self-insured group health plans offered in such market)" after "such market." Insurers must accept everyone who applies for coverage.

2014

1201

Adds section 2702 to the Public Health Services Act Adds section 2703 to the Public Health Services Act Adds section 2705 to the Public Health Services Act Adds section 2706 to the Public Health Services Act Adds section 2707 to the Public Health Services Act Adds section 2708 to the Public Health Services Act Adds section 2709 to the Public Health Services Act

2014

1201

Insurers must renew coverage for everyone who has it. Insurers can't restrict you from getting a plan based on past illnesses, genetic history, a disability, previous health care you've gotten, because you were the victim of domestic violence... basically, your personal health history is off-limits when it comes to insurers deciding what plans you can apply for. If a doctor or hospital is willing to work with an insurer, the insurer has to let them.

2014

1201

2014

1201

2014

1201

Reiterating that all plans offered must cover the stuff specified by the other sections of this bill.

2014

1201 + 10103 RECON 1201 + 10103 RECON

Waiting periods can't be longer than 90 days. Amended to strike "or individual." Insured customers should have access to "Clinical Trials" (essentially drugs still being tested and not approved for commercial sale yet), and that their insurer shouldn't be able to screw with their insurance plans because they choose to participate in one. Says that when this law passed, no one had to change their plans. They could if they wanted, but they could totally keep their current plan if they like it. Says that the changes this law makes apply to all health plans companies offer, not just some. The Secretary of Labor needs to make a yearly report to Congress on self-insured employers.

2014

2014

1251 1252 1253 + 10103 RECON

2014 2014 2011

1254 + 10103 RECON 1255

The Secretary of HHS needs to write a report on group health plans. Specifies when parts of the Title go into effect (mostly in 2014). Defines what a "qualified health plan" (QHP) needs to be. It is basically the minimally acceptable health coverage an insurance company may sell. It needs to be certified for the requirements of the insurance exchange it's going to be in (more on the exchanges later), it needs to have the features described in the next section, needs to be sold by a licensed insurer, needs to be sold at the same rate regardless of whether it's sold directly or in an exchange, etc. Amended to refer to plans sold through Co-ops (see section 1322) and multistate plans (see section 1334). This section describes what a QHP must consist of -- "essential health benefits package." The Secretary of HHS is going to determine what the minimum levels need to be for everything, but this section outlines that by saying that QHPs must cover bare minimums of ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health services, drugs, rehabilitative services, laboratory services, preventative services, and pediatric services that include oral and vision care. This section also goes into detail on just how the Secretary is to determine those minimum levels (be mindful of different types of people, be balanced, etc.). This section also limits how big deductibles can get starting in 2015 (no bigger than $2000 for individuals and $4000 for couples). On top of that, this establishes that plans should fall into Bronze/Silver/Gold/Platinum levels, with each corresponding to a different level of benefits. For Bronze, insurers pay for 60% of the costs of the benefits, Silver is 70%, Gold is 80% and Platinum is 90%. A plan that's not one of those could still be okay if it's a Catastrophic plan, which is only for people under 30 or with special tax exemptions, and it only has to cover three primary care visits. Additionally, any plan created for adults must also be available for children under 18. A state may choose "to prohibit abortion coverage in qualified health plans offered through an Exchange in such State" by enacting "a law to provide for such prohibition." This section defines a bunch of terms related to health insurance exchanges, which are government-run online market places for private & nonprofit insurers to offer subsidized health coverage for "qualifying" individuals. P/x: The theory is that by having more insurance companies competing across a larger area, prices will be driven down due to competition. Since the public option got shot down before the bill was passed, this was seen as another way to encourage more competition in the market.

2011

1301

2014

1302

2014

1303 + 10104 (RECON )

2014

1304

2014

1311

1312

Provides that states must establish exchanges or leave to federal government. This section sets aside money to the states so they can start up health insurance exchanges. The Secretary of HHS determines how much to keep giving the states based on how much progress they're making. States only have until 2015 to get their act together, though - after that they get no money. However, states must have something ready by 2014. States can choose to require insurers to have benefits that go above and beyond what this law requires, but they have to figure out how to pay for anything they come up with that requires more government money. By 2015, the exchanges need to be selffunding. States can even team up to make multi-state exchanges if they want. Individuals can get any plan they qualify for. If you qualify for it, you can get it, if you don't, you can't. This section seems to be talking about different ways people can get insurance (through employment, through a broker, etc.), and making sure they get it. Also, Congress has to make use of the same plans us ordinary taxpayers have. Starting in 2017, states may permit large employers to purchase coverage through Exchanges. States need to keep track of the money these insurance exchanges are using, make sure they're working right financially, and watch out for fraud. The Secretary of HHS is to set the standards that these insurance exchanges are supposed to follow. If any state fails to follow them satisfactorily, fails to get it set up in time, or chooses not to do it at all, the Secretary will set one up for them. Amends sections of IRC This sets up the rules, as well as instructions for loans and grants, for the creation of non-profit, member-run insurers called Co-ops. Allocates money specifically for territories that aren't states, like Puerto Rico. This says that Co-ops have to work under the same laws as normal insurance companies. This allows the government to create a low-cost insurance option for people who make too much money to qualify for Medicaid, but who still make less than 200% of the poverty line (which is a number that depends on your age and how many are in your household, but this amount, at its lowest is a little over $20,000/year). If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Services for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer.

2010

2014

1313

2014

1321

2014

1322 1323 1324

Repealed. See H.R. 1473.

1331

2014

1332

1333 1334 + 10104 RECON

1341

1342

1343

1401(a)

Adds sections 36B and 280C(g) to IRC

1402

1411

1412

States can work with insurers to allow them to make plans available in multiple states with different laws and regulations Provides for the establishment of multi-state plans and gives the Director of OPM the power to enter into contracts with insurers to offer multi-state plans through an Exchange. States must either create or work w/an already-existing nonprofit reinsurance agency. Reinsurance agencies buy insurance plans from insurers when they are deemed to be highrisk. This helps to keep premiums for other customers down, since otherwise insurers would have to raise prices to offset that risk. This section talks about some of the rules for these sorts of agencies. 50-100 medical conditions are to be identified as high-risk conditions that insurers can offer up to reinsurance agencies. Partly to offset the risk these agencies are taking by taking on these high-risk customers, reinsurers are tax-exempt. The government will create "Risk corridors" for individual and small group markets. Essentially, in the first two years while insurers adjust to all these new rules going into effect in 2014, the government will help with some of the risk associated with insurance payouts. Each state will charge insurers who take on less risk, and make payments to insurers who take more risk, acting as an equalizer so that the companies that succeed aren't just the ones who cater mostly to demographics with a low amount of risk. Gives a refundable tax credit to everyone who makes too much to qualify for Medicaid, but makes less than 400% of the poverty line (which, again, is based on your age and how many people are in your household). A refundable tax credit is basically a discount on your taxes, and if it's more money than you pay in taxes, you actually get the extra money back as a refund. Insurers must reduce costs for everyone who makes too much to qualify for Medicaid, but makes less than 400% of the poverty line. Depending on how much you make, your co-pay costs could be slashed by up to two-thirds the normal price, and your overall costs could be covered up to 94%. If you're an American Indian making under 300% of the poverty line, you have no co-pay. This section specifically says it only applies to citizens and legal aliens living in the US (so no illegal aliens allowed). Instructs the Secretary of HHS to set up a way to check whether people are eligible to buy insurance. It looks like it's basically, in a roundabout way, trying to keep illegal aliens from being qualified for insurance, and setting up penalties for anyone who lies on insurance forms. This section instructs the Secretary of HHS to set up a way to check whether people are eligible for the tax credits and the insurance cost reductions (that "up to 400%" stuff). Basically, instructing him to set up a system to determine what people qualify for based on their income and legal resident status.

2013

20142016

20142016

2014

2014

1413

Amends sections of IRC Amends sections 6103 and 7213 of IRC Amends section 36B of IRC

This section instructs the Secretary of HHS to set up standard forms and enrollment procedures for state-level programs like Medicaid and Child Health programs. The Secretary of HHS is allowed to share relevant tax information with those who need it in order to verify what people qualify for. All these tax credits and refunds won't count as income. So they won't be taxed or anything. The Secretary of HHS is instructed to conduct a study into the possibility of adjusting poverty levels based on where people live (cost of living adjustment).

1414

1415

1416 Adds to section 38 of IRC Adds section 45R to IRC

1421(b) 1421(a)

1501(a)

Adds section 50A to IRC

1501(b)

Adds section 5000A to IRC

1502(a)

Adds section 6055 to IRC

Provides a tax credit to up to 35% of the cost of health care a Small Businesses (one with 25 or fewer employees) provides to their employees. It is part of general business credit and allow against alternative minimum tax. Small Businesses are eligible for a tax credit worth up to 50% of the cost of the health care they provide their employees. This is a lengthy explanation for the reasons behind the "individual mandate." The basic theory is, without it, people might just decide not to pay for insurance, which places a huge risk not just on themselves, but the hospitals who will eventually have to treat them when they get sick or injured. The economy loses a ton of money due to uninsured people needing emergency care, which in turn makes insurance premiums more expensive as that cost is passed on. What's more, medical expenses account for 62% of bankruptcies, which introduces even more stress into the economy. And with this bill getting rid of "pre-existing conditions", if there was no mandate, people would just wait to buy insurance until they need it, which pretty much defeats the whole point of insurance. In addition, requiring people to get insurance will make millions of people healthier and live longer. Besides, the more healthy people who have insurance, the less of a risk insurers are taking, which lowers everyone's prices. This is the actual mandate. If you can afford healthcare (if it costs less than 8% of your income), but don't get it, you will be hit in your tax return with an annual tax of $95, or up to 1% of income, whichever is greater. This will rise to $695, or 2.5% of income, by 2016. This section makes an exception for those with religious exemptions (the Amish), members of Indian tribes, and prison inmates, and those experiencing "hardships." It also specifies that only civil penalties apply to enforce tax. Insurers need to tell the government who they're insuring, either directly or through employers, in which case they need to tell the government which employer they're working through too. Provides for assessable penalties for failing to report.

20102013 20142016

2014

2014

2015 (delayed)

1511

Adds section 18A to Fair Labor Standards Act of 1938 Adds section 18B to Fair Labor Standards Act of 1938

If an employer has over 200 employees, and offers a health plan to those employees, new employees will be automatically signed up for that health plan, though employees can opt-out if they don't want it. Employers must provide written notice informing employees about their options with health insurance exchanges and potential eligibility premium tax credits if the employer's share of costs is less than 60% of the allowed total cost of benefits. If an employer has over 50 full-time employees and doesn't offer them insurance, the employer has to pay a fee of $2000/year per employee. If they employ part-time employees, their hours are to be added together to see how many full-time employees they'd represent (in other words, it's not a simple head count). The Secretary of Labor is to conduct a report to see what effect this has on employees' wages. Employers need to report to the Secretary of Health and Human Resources about the insurance being used by the employees working for them. You cannot get a "cafeteria plan" using an insurance exchange (a plan where you specifically pick what is and isn't covered). Says that this part of the bill uses the same definitions as the Public Health Service Act. 30 days after this act passed, the Secretary of HHS had to publish online all of the authorities he has been given under the act. The Federal Government, States, and insurers cannot discriminate against doctors and hospitals that refuse to do assisted suicide. The Secretary of Health and Human Services will not promote regulation that limits peoples' ability to get health care, or limits doctors' ability to communicate with patients. Any Federal Health Insurance Programs created by this act are optional (anything like Medicare and Medicaid, for example). No one has to join them. Extends date to cover recent issues involving health problems suffered by coal miners. Health insurance programs benefiting from Federal credits and subsidies cannot discriminate against anyone based on age, gender, race, etc.

2010 (but awaiting IRS regulation s)

1512

2013

1513

Adds section 4980H to IRC

2014

1514(a)

Adds section 6056 to IRC Amends section 125(f) of IRC Amends the Public Health Services Act Amends the Public Health Services Act Amends the Public Health Services Act Amends the Public Health Services Act Amends the Public Health Services Act Amends Black Lung Benefits Act Amends the Public Health Services Act

2015 (delayed)

1515

2014

1551

1552

2010

1553

1554

1555

1556

1557

1558

Adds section 18C to the Fair Labor Standards Act of 1938 Amends the Public Health Services Act Amends the Public Health Services Act Amends section 3021 of the Public Health Services Act

Employers can't discriminate against employees that have received tax credits.

2010 (effectivel y 2014)

1559

The Inspector General of the Dept. of HHS is in charge of administration and implementation of this law, as it pertains to his department. States that "nothing in this title shall be construed to modify or supersede the operation of any of the antitrust laws," Hawaii's Prepaid Health Care Act, student health insurance plans, or "any existing Federal requirement concerning the State agency responsible for determining eligibility for programs identified in section 1413." 180 days after this bill was passed, a couple of Health Information Technology committees will work to start spreading information and helping people enroll in HHS programs. The Comptroller General of the US is directed to conduct a study on the denial of coverage; details how he's to go about doing it. 2011

1560

1561

1562 + 10107 RECON 1563 Amends the Public Health Services Act Amends section 715 of the Employee Retirement Income Security Act Adds section 9815 to IRC

Makes many small changes include slight alterations and rewordings, additional definitions of terms, and language that fits in better with this bill. Adds that the rules in that document apply to group insurance plans as well as individual insurance plans. States that sections 2716 and 2718 (as amended by this Act) shall not apply to selfinsured group health plans. Adds that the rules in that document apply to group insurance plans as well as individual insurance plans. States that sections 2716 and 2718 (as amended by this Act) shall not apply to selfinsured group health plans. Basically says that the CBO says this bill will reduce the budget deficit, extend Medicare solvency, increase the Social Security Trust Fund, and have savings in a few other areas. It also says that these savings will go towards those programs and not folded back into the PPACA.

1563

1563

1564

APPENDIX B: Title II (Role of Public Programs) Effective Date

PPACA

Codification

Description Everyone up to 133% of the poverty line is covered by Medicaid. From what I can tell, looking at the Social Security Act, it looks like it currently list various qualifications, one being that a person is under 100% of the poverty line. So this provision will increase the number of people who qualify for Medicaid in 2014. This section also increases federal funding to support the increase. However, it should be mentioned that the Supreme Court has made it clear that individual states could opt not to do this. However, in Justice Roberts' opinion "Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer." In other words, States can't be forced to do this, but they can be given incentives to do this. Medicaid will cover former foster children under the age of 26. Increases the amount of Medicare money given to US Territories.

2001

Amends the Social Security Act

2014

2004 2005 2006

Amends the Social Security Act

2014

Amends the Social Security Act

It apparently increases the amount of Federal money given for medical care when there is a major disaster. Between 2014 and 2018, this cuts about $700,000,000 from a part of Medicaid called the Medicaid Improvement Fund, a yearly fund established to improve the management of Medicaid. This provision was created to help fund this bill, which itself tries to improve Medicaid (along with everything else). Between October 2005 and September 2009, the amount of money allocated to the Children's Health Insurance Program (CHIP) increases, and this section says that states that want to get this increased funding need to make sure that the health insurance provided under CHIP meets the same standards as those in this bill. This calls for the creation of a website for people who use Medicaid and CHIP to sign up for and renew insurance plans using their state's insurance exchanges. Apparently allows a hospital to choose whether they want to be able to make a determination whether or not a patient is covered under Medicaid. I'm just guessing here, but I think that this is to streamline things and make it easier for hospitals to sign patients up for Medicaid if a patient looks like they might

2011

2007

2014

2101

Amends the Social Security Act Adds section 1943 to the Social Security Act Amends the Social Security Act

2201

2202

qualify for Medicaid. Amends the Social Security Act Allow Medicaid to cover "Freestanding Birth Centers", which look like they are essentially an establishment which is not a hospital, but which provides services to mothers giving birth. So... picture a maternity ward without the rest of the hospital, and that seems like the sort of thing they're describing. if a child has been diagnosed with a terminal illness, and the parents have chosen to pay for hospice care, that paying for hospice care doesn't mean that they are giving up any other forms of care that Medicaid and CHIP might provide for their child as well Provide those with a low income (an amount which is to be decided by each State) access to family planning medical services. From what I can tell, this means stuff like STD testing, contraceptives, etc. States may provide those with an income level under 150% of the poverty line (which, like I said in Part 1, is based on your age and how many people are in your household) care in a nursing home, in-home care, etc. This section is optional for states to follow, but those that choose to do it (and follow numerous standards set in place by this section) will benefit from an increase in Federal funding. Directs the Secretary of HHS to create regulations for various types of state-provided long-term care (again, stuff like nursing homes and in-home care), allowing states to cater to those who could benefit from different kinds of long-term care while still working within pre-set standards. This has do with states funding long-term care, and transitioning into and out of hospitals (as opposed to nursing homes and in-home care). The Deficit Reduction Act had a part to smooth this transition, and this section extends that part, as well as expanding the people it can cover (based on how long a person has been receiving long-term care). It's hard to parse through this one, since it bounces around to different sections of the Social Security Act, but the gist of it seems to deal with a part of the Social Security Act that happens when your spouse becomes institutionalized in some form of long-term care, and the state helps with your expenses during that time (because long-term medical care can be costly). This section seems to make it so that from 2014-2019, this help also includes medical coverage. Sets aside $50,000,000 (over a five-year period) to help pay for another bill, the Older Americans Act of 1965.

2301

2302

Amends the Social Security Act Amends the Social Security Act

2303

2401

Amends the Social Security Act

2011

2402

2403

Amends the Deficit Reduction Act of 2005

2404

Amends the Social Security Act

2014-2019

2405

Refers to the Older Americans Act of 1965

2406

Reiterates how important a topic long-term care is, and says in a general way that Congress should talk about it more and that more support should be made for community-level care (like nursing homes and in-home care) as opposed to only hospital care. Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act Increases the size of the drug rebates poor people get through Medicaid, and also specifies that no rebates are to be for an amount higher than the average price of the drug. Allows Medicaid to cover more types of drugs, including Barbiturates, Benzodiazepines, and drugs that help people to quit smoking. Sets a way to determine what the limits are for how much Medicaid is supposed to reimburse people for pharmacy drugs. This one is cutting a lot of money from payments made to states called Disproportionate Share Hospital (DSH) Payments. These are payments that states then turn over to hospitals to help compensate them for treating emergency patients who don't have insurance. From 2014-2020, $18.1 Billion will be cut from the amount given to states for this, and the Secretary of HHS is to decide how much each state gets cut based on what percentage of their population is insured, as well as a few other factors. P/x: The theory is that since more patients will have insurance after the PPACA goes into full swing, hospitals won't need as much of these funds. Gives States the option to get 5-10-year waivers so they don't have to follow Federal regulations for Medicaid when it comes to "Demonstration Projects" (See 2704-2707), which looks like they are ways to test out new alternate approaches to Medicaid. However, the Secretary of HHR can pull the plug on these waivers if it looks like a Demonstration Project isn't working the way it is intended. Directs the Secretary of HHR to create the Federal Coordinated Health Care Office, which is in charge of managing the areas of overlap between Medicare and Medicaid, to make it more effective and efficient for people who qualify for both to get the services they're covered for, and make sure there's not any waste. On a yearly basis from 2011-2014, and then every three years after 2014, the Secretary of HHS is to write a report on recommended standards for adult care for Medicaid patients, much like a similar report that's already written for children. This section also calls for the establishment of the Medicaid Quality Measurement Program to develop and test better methods of adult care (again, like a similar program already in existence for children). $60 Million will be set aside every year from 2010-2014 to fund this program. NOW

2501

2502 2503

2551

Amends the Social Security Act

2601

Amends the Social Security Act

2602

2701

Adds section 1139B to the Social Security Act

2702 Amends the Social Security Act

2703

Directs the Secretary of HHS to look at individual state practices that withhold payment from hospitals for health conditions caused by the hospitals' own neglect and negligence, and adopt them as general Medicaid practices. States may choose to offer medical plans for those with chronic conditions that they're calling a "Health Home", which appears to mean a team of specialists assigned to look after you and coordinate your care. From 2012-2016, the Secretary of HHR will start up a "Demonstration Project" to test the effectiveness of doing bundled programs in Medicaid. From 2010-2012,The Secretary of HHR will start up another "Demonstration Project" to give participating states an option to try out a different Medicaid payment structure for hospitals, so instead of paying hospitals based on the quantity of service they give, it's based on the quality. From 2012-2016, The Secretary of HHR will start up another "Demonstration Project" to give states the opportunity to allow hospitals to become "Pediatric Accountable Care Organization," which looks like it's a way to reward pediatric hospitals who find ways of saving money without reducing the amount of care patients receive. The Secretary of HHR will start up another "Demonstration Project" to give states the opportunity to allow private psychiatric hospitals to be covered under Medicaid. This section allocates $75 Million for this, and specifies that it will be a three-year project that will happen sometime between 2011 and 2015. Tries to improve MACPAC, which looks like it handles Medicaid and CHIP payments. This section clarifies wording, emphasizes efficiency and preventive care, and adds in a bunch of directions to communicate more clearly and frequently with Congress and the states, as well as coordinating with MedPAC, which handles Medicare payments. It also allocates $9 Million for this in 2010, as well as reallocating $2 Million from Social Security for this (out of $12 Billion that year - so comparatively speaking not much). Goes into more detail on some rules regarding Native American Indians and the Indian Health Service. Extends reimbursement to Native American Indian hospitals under Medicare Part B, previously due to expire in 2010.

2011

2704

2012-2016

2705

2010-2012

2706

2012-2016

2707

2011-2015

2801

Amends the Social Security Act

2901 2902 Amends the Social Security Act

2951

Adds section 511 to the Social Security Act

6 months after the bill passes, all states must conduct a "statewide needs assessment" to identify communities with high levels of crime, poverty, etc., how good state programs are at providing at-home medical visits for children, and the effectiveness of substance abuse treatment programs. States must report this information to the Secretary of HHR, as well as informing the Secretary of what they intend to do to improve the situation in their state. This section authorizes the Secretary to make grants to states for these improvements (with an emphasis on communities in particularly bad shape), and directs the Secretary to track the improvements made after 3-5 years. This section also directs the Secretary to coordinate these efforts with the Maternal and Child Health Bureau and the Administration for Children and Families. From 20102014, $1.5 Billion is set aside for this section. Directs the Director of the National Institute of Mental Health to conduct a study on postpartum depression. Directs the Secretary of HHS to use grant money for projects to diagnose and treat postpartum depression. The Secretary is to track the progress of these projects and report to Congress on the results. $3 Million is set aside for this in 2010, and "sums as may be necessary" in 2011 and 2012. From 2010-2014, the Secretary of HHR will give each state funding (based on the size of that state's population between ages 10-19) for sex education programs (pushing both abstinence and contraception). $375 Million is to be set aside for this from 2010-2014, with some of that specifically set aside for youths who are homeless, have AIDS, live in areas with high youth birth rates, etc. Along with this, there are calls for studies to see how effective these programs are in reducing youth pregnancy rates. Reinstates funding for abstinence-only sex education programs from 2010-2014 to states. Children without a parent (or who don't want their parents to be in charge of their medical decisions) are given more information about the importance of designating a Power of Attorney when it looks like they may need one to make medical decisions for them.

2010-2014

2952 Adds section 512 to the Social Security Act

2952

2010-2012

2953

Adds section 513 to the Social Security Act

2954

Amends the Social Security Act Amends the Social Security Act

2010-2014

2955

2010

APPENDIX C: Title III (Improving the Quality & Efficiency of Health Care) PPACA 3001 Codification Amends the Social Security Act Description The Secretary of HHS will establish a "hospital value-based purchasing program" so that instead of reimbursing hospitals based on the number of patients they have treated, they are reimbursed based on their success with a measure of specific conditions (heart failure, pneumonia, acute myocardial infarction), surgeries, and stuff like negligence. These measures are to take into account stuff like age, sex, race, severity of illness, etc., as well as the hospitals' prior success with these conditions, how much they've improved, and how they compare to other hospitals. Extends a program called the Physician Quality Reporting System, which offers an increase in pay as an incentive to doctors to report to the Secretary of HHS about the quality measures taken in their hospital. This amount decreases in 2012, and ends in 2015. Starting in 2015, doctors who fail to make these reports will have their pay reduced, and in 2016 it will be reduced even further. Direct the Secretary of HHS to starting using claims data (and possibly other data) to give doctors information about resources and methods available to them to improve care for their patients. Long-term care hospitals that fail to report to the Secretary of HHS about the quality measures taken in their hospital will receive reduced funding. Directs "PPS-Exempt Cancer Hospitals" to report to the Secretary of HHS about the quality measures taken in their hospital. Directs the Secretary of HHS to develop a "value-based purchasing plan" in Medicare for "skilled nursing facilities", "home health agencies" and "ambulatory surgical centers", to make the pay they get under Medicare to be based on the quality of care they give based on criteria to be determined by the Secretary. Directs the Secretary of HHS to come up with a "value-based payment modifier" to begin in 2013, which will pay doctors based on the quality and cost-effectiveness of their care (based on measures to be set by the Secretary). Hospitals get less money when they treat patients for problems caused by their own negligence. This section also directs the Secretary of HHS to conduct a study in 2012 to see how this change will affect quality of care and costs. Effective Date 2013

3002

Amends the Social Security Act

3003

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

2012

3004

2014

3005

2014

3006

3007

Amends the Social Security Act Amends the Social Security Act

2013

3008

2015

3011

Adds section 399HH to the Public Health Service Act

3012

Directs the Secretary of HHR to create a report in 2011 on a strategy to improve the delivery of health care services that will be presented to Congress. This strategy will be updated at least once a year, with annual updates submitted to Congress. Directs the President to put together an "Interagency Working Group on Health Care Quality," comprised of senior representatives from numerous agencies and departments (everything from the Department of HHS to the US Coast Guard), with the purpose of coordinating efforts between departments as they pertain to the strategy outlined in the last section. This group is to present a yearly report to Congress on their progress and recommendations. Directs the Secretary of HHR to consult with the Director of the Agency for Healthcare Research and Quality and the Administrator of the Centers for Medicare & Medicaid Services at least three times a year to look for any gaps in their quality measures. The Secretary will award grants to expand these quality measures as needed. This section also directs the Administrator of the Center for Medicare & Medicaid Services develop quality measures for those programs. From 2010-2014, $375 Million will be set aside for this section. The part of the Social Security Act it refers to creates a privately-owned non-profit group comprised of both health insurance representatives, as well as representatives of consumer advocacy groups, whose job it is to recommend ways to improve the quality and efficiency of health-care. What this section looks like it does is direct this group to recommend specific measures, and direct the Secretary of Health and Human Resources to keep track of how well these measures do. The language is a bit confusing, but it looks like this section directs the Secretary of HHR to create more efficient ways to collect data on the cost and effectiveness of health care, and directs the Secretary to give grants and contracts to organizations and individuals that will assist in this task. Directs the Secretary of HHR to create a website to report to the public on how successful the measures taken to ensure quality of care have been. This report will be provider-specific, so it looks like this will actually be a way to compare how effective different health care providers are.

2011

3013

Adds section 931 to the Public Health Service Act / Amends the Social Security Act

3014

Amends the Social Security Act

3015

Adds section 399II to the Public Health Service Act Adds section 399JJ to the Public Health Service Act

3021

3022

Adds section 1899 to the Social Security Act

Secretary of HHS is to establish the Medicare Shared Savings Program. This program allows for the creation of Accountable Care Organizations (ACOs), organizations comprised of a group of health care providers (hospitals, doctors, etc.). These organizations may then receive payments for lowering costs while maintaining standards of care for Medicare patients. The Secretary of HHS is to determine what these standards are, and how they are to be measured and reported. Basically, if a hospital or other qualified group of caregivers can find ways to reduce Medicare costs without sacrificing quality of care, they'll be rewarded for doing so (and undoubtedly successful methods can then be extended to other areas of Medicare). Secretary of HHS to establish a "pilot program" to test to see if hospitals and doctors bundling payments (like how your cable and internet bill might be bundled) can help to lower costs without lowering the quality of care for patients. By 2015, the Secretary is to report to Congress on the progress of this program. By 2016, the Secretary is to report to Congress on the results of this program. Secretary of HHS to create a "demonstration program" to test payment incentives for doctors, nurses, etc. that provide on-call 24/7 in-home care. Basically, it looks like the thinking is that maybe if people with chronic conditions can get check-ups at home, they'll be less likely to need to go back to the hospital repeatedly for the same problem, less likely to make a trip to the emergency room, and more likely to get better-quality care. The Secretary of HHS is to develop standards for the care given to patients, and doctors who can reduce the costs of care for their patients while still meeting these standards will get incentive payments. $30,000,000 is set aside for this program from 2010-2015, and the Secretary is to report to Congress on its progress. Payments made under Medicare to hospitals will be slightly reduced in cases of excessive readmission. This is apparently to encourage hospitals to fix the problem a patient comes in with in the first place. The next few sections focus on reducing readmissions, where a patient keeps coming back for the same problem. P/x: High readmissions are purportedly a big drain on Medicare. "One in five patients discharged from a hospital approximately 2.6 million seniors - is readmitted within 30 days, at a cost of over $26 billion every year" Within two years of the enactment of this section, the Secretary of HHS will make a program for hospitals with a high amount of readmissions to improve their readmission rates. So, while the previous section penalizes them for having too many readmissions, this one helps them to get their readmissions to acceptable levels. Hospitals that do this will report to the Secretary on the changes they make and how effective they are.

2012

3023

3024

Adds section 1866E to the Social Security Act

2012

3025

Amends the Social Security Act

2012

3025

Adds section 399KK to the Public Health Service Act

2012

3026

3027

3102

Amends the Deficit Reduction Act of 2005 Amends the Social Security Act Amends the Social Security Act Amends Medicare, Medicaid, and SCHIP Benefits Improvement s and Protection Act of 2000 Amends the Social Security Act Amends Medicare, Medicaid, and SCHIP Extension Act of 2007 Amends Medicare Improvement s for Patients and Providers Act of 2008 Amends the Social Security Act

The Secretary of HHR will create a program to try and improve the care for patients being transitioned from one location (like a hospital) to another (such as the at-home care or CommunityBased Organizations. Extends a demonstration project in that bill to last roughly another year, and setting aside an additional $1,600,000 for this. Renews part that sets a bottom limit for the Work Geographic Index (used for determining Medicare costs), as well as adding what looks like some additional criteria for determining those costs. Renews part that allows people to be exempted from some of the costs due to physical therapy expenses. This provision is ridiculously hard to understand, but it seems to simply extend Medicare payments for laboratory services for an additional year (until 2010).

2011-2016

3103 3104

-2010

3105

3106

Also difficult to understand, but it's seems to simply renew funding for ambulance services for Medicare patients through 2011. Hard to understand; renews funding for long-term care hospitals for Medicare patients for another two years.

2010-2011

2010-2012

3107

Extends funding for mental health treatments for Medicare patients an additional year (until 2010).

-2010

3108

Physician Assistants are added to the list of professionals (line nurses and doctors) allowed to order "post-hospital extended care services" that a patient can be given after a 3+ day stay at a hospital. P/x: Gives physician assistants more freedom to sign you up for services you need after a long hospital stay.

2011

3109

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

Clarifies when pharmacies have to send accreditation information regarding their quality standards to the Secretary of HHS, as well as indicating exemptions for certain types of pharmacies. Some beneficiaries of Tricare (civilian health benefits for veterans) will have an additional year to enroll in Medicare Part B, if they choose to do so. Reduces the amount paid to hospitals for X-Ray bone density scans in 2010 and 2011, as well as directing the Secretary of HHR to work with the Institute of Medicine of the National Academies to conduct a report on the effect that this has. Cuts all the funds going to the Medicare Improvement Fund in 2014. This cuts $22,290,000,000. Directs the Secretary of HHS to conduct a two-year demonstration project, starting July 1, 2011, where complex lab tests are paid using separate payments. No later than two years after the demonstration project is completed (so by July 1, 2015), the Secretary is to report to Congress on how this affected expenses and quality of care. $5,000,000 is set aside for this section from the Centers for Medicare & Medicaid Services Program Management Account, and the actual payments themselves are to get funds from the Federal Supplemental Medical Insurance Trust Fund. Nurse-midwife services received through a fee schedule can receive up to as much as if those same services were administered by a doctor. The apparent purpose is to make nurse-midwife services more accessible. Renews Medicare coverage for outpatient services in rural hospitals for another year (through January 1, 2011). Extends from July 1, 2010 to July 1, 2011, payments to rural hospitals for clinical diagnostic laboratory tests covered under Medicare Part B. 2011 -2010

3110

3111

2010-2011

3112

2014

3113

3114

Amends the Social Security Act Amends the Social Security Act Amends Medicare Prescription Drug, Improvement , and Modernizatio n Act of 2003 Amends Medicare Prescription Drug, Improvement , and Modernizatio n Act of 2003

3121 3122

2010 2010-2011

3123

Extends for an additional 5 years (ending sometime in 2014) a demonstration project to establish rural community hospitals. In addition, the number of these hospitals is doubled from 15 to 30, and the Secretary of HHS is to expand the states in which these hospitals can be located. This section also makes a series of seemingly minor changes to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make the language fit better.

2010

3124

Amends the Social Security Act Amends the Social Security Act

Extend the Medicare Dependent Hospital (MDH) program for rural hospitals for another year (through October 1, 2012). For the fiscal years 2011 and 2012, the amount paid to lowvolume hospitals is increased by up to 25%, based on how many patients they've discharged. In addition, for those years, what qualifies as a "low-volume hospital" is expanded to include hospitals that are over 15 miles away from another qualifying hospital (instead of 25 miles away). Expands a demonstration project revolving around community-level integrated health services on a county-bycounty level. This section also removes the restriction on the number of counties that can be included in this demonstration project, and replaces some terminology. Directs the Medicare Payment Advisory Commission to conduct a study on how adequate payments to rural hospitals are. This report is to be given to Congress by January 1, 2011.

2010-2012

3125

3126

Amends the Medicare Improvement s for Patients and Providers Act of 2008

3127

2011

3128 3129

Amends the Social Security Act Amends the Social Security Act

Increases payments for emergency hospital services and ambulances from 100% of what is deemed a "reasonable cost" to 101%. Gives grant money to rural hospitals, which stays available until it is used rather than expiring. AMT? It also adds that this grant money can now be used to make sure these hospitals are up to the standards set in the PPACA.

2010

3131

Amends the Social Security Act and the Medicare Prescription Drug, Improvement , and Modernizatio n Act of 2003

The Secretary of HHS will start to phase in changes to the amounts paid to caregivers for home health services, based on a number of factors, including the type and cost of services, whether the caregiver is rural or urban, whether the caregiver is for-profit or non-profit, etc. The phase-in is to be across 4 years, to make sure the shift in payments isn't too much of a shock to the market. In addition, this section directs the Medicare Payment Advisory Commission to conduct a study on the effect this has on access to and quality of care. This report is to be given to Congress by January 1, 2015. On top of that, this section makes a number of smaller edits to indicate that the Secretary is to limit the amounts paid to these caregivers in a number of different ways. This section also alters another bill, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, to increase the payments made to rural home health services by 3% from April 1, 2010 to January 1, 2016. The Secretary is to conduct a study on home health agency costs for Medicare beneficiaries. The Secretary is to present this report to Congress no later than March 1, 2014. Also, after seeing the results of this study, the Secretary may conduct a demonstration project to test the changes recommended to improve services. If the Secretary decides to go ahead with this demonstration project, it is to last for four years, and start no later than January 1, 2015. The Secretary is to set aside $500,000,000 from the the Federal Hospital Insurance Trust Fund to fund both the study and the demonstration project. And if the Secretary does choose to go ahead with this demonstration, he is to evaluate and report on it to Congress. Directs the Secretary of HHS to gather data on payments for hospice care starting no later than January 1, 2011. At some point after October 1, 2013, the Secretary is to revise payments for hospice care. This section also says that a hospice care provider can only continue services if every 180 days they have a face-to-face meeting with the patient to determine whether that patient still needs hospice care. Changes the method for determining disproportionate share hospital payments (payments to hospitals who treat indigent patients), to be determined by a number of factors outlined in the provision It's a bit complicated, but apparently it cuts these payments by about 75%. P/x: cut is on the basis that hospitals will have fewer uninsured patients to treat by 2014.

2014

3132

Amends the Social Security Act

2011

3133

Amends the Social Security Act

2014

3134

Amends the Social Security Act

Directs the Secretary ofHHS to identify which services are "misvalued" (that are more expensive than they need to be or can be made more efficient through bundling). The Secretary is to make downward adjustments to the amount we pay hospitals for these services. This section also repeals a part of another bill, the Balanced Budget Act of 1997, that seems to direct the Secretary to just accept the generally accepted costs for these services. It also repeals a part of the Social Security Act that I'm having difficulty finding, but apparently said something similar. Starting in 2011, it's increasing from 50% to 75% a rate used in determining expenses related to costly diagnostic imaging equipment. and reduces the payments for the use of this equipment by 25%. This section also directs the Chief Actuary of the Centers for Medicare & Medicaid Services to report on whether this change in payments will reduce costs by $3,000,000,000. That report is to be made available no later than Jan. 1, 2013. Changes the Medicare payment for powered wheelchairs. Beginning on January 1, 2011, for the first three months of paying for a powered wheelchair, it goes up from 10% of the cost to 15% of the cost, and for subsequent months it goes down from 7.5% of the cost to 6% of the cost. This provision was incredibly difficult to understand. The section alters another bill, the Tax Relief and Health Care Act of 2006, directing the Secretary of HHR to report to Congress no later than December 31, 2011 on reforming the hospital wage index, which determines how Medicare will compensate various medical professionals. Anyway, the Secretary's report is to take numerous factors into consideration. P/x: This provision is intended to contain costs. See Law, Explanation and Analysis of the Patient Protection and Affordable Care Act: Including Reconciliation Act Impact 495 (vol. 1, 2010). Direct the Secretary of HHS to conduct a study on the costs associated with cancer hospitals compared to other hospitals. The secretary will determine an adjustment (presumably to payments) to account for the difference in costs. Refers to payments for biosimilar biologics. Biologics are medical treatments made from living organisms (like vaccines), and "biosimilar" refers to products that are effectively the same as existing products. This section says that Medicare will pay 106% of the cost of existing products for these biosimilar ones. P/x: To lower cost by giving upstart drug companies a chance to break into the market so they can compete with major drug companies that already exist. 2011 2011

3135

Amends the Social Security Act

3136

Amends the Social Security Act

3137

Amends the Tax Relief and Health Care Act of 2006

3138

Amends the Social Security Act Amends the Social Security Act

3139

3140

Directs the Secretary of HHS to establish a Medicare Hospice Concurrent Care demonstration program, which will last for 3 years. Hospice care is care for patients who are dying that doesn't attempt to treat the ailment that the patient is dying from, it only tries to ease their pain. Generally, Medicare recipients have to choose one or the other. The demonstration program this section creates will allow for some patients to choose both. This demonstration program is intended to be cost-neutral, and the Secretary is to report to Congress on how this affected quality of care and cost-effectiveness. Directs the Secretary of HHS in how to go about calculating the Hospital Wage Index Floor apparently, to ensure that no hospital has a wage index beneath what is legally required, while still making the changes in wage indexes budget neutral. Directs the Secretary of HHS to conduct a study on costs and payments in urban Medicare-dependent hospitals. Within 9 months of the enactment of the PPACA, the secretary will submit this report to Congress. Says that nothing in the PPACA will reduce home health benefits guaranteed in the Social Security Act. Amends the Social Security Act Amends the Social Security Act Involves lots of numbers; seems to lower the amount paid for Medicare Advantage until the costs are more in line with the costs of normal Medicare. Some specific services under Medicare Advantage cannot cost more than those under Medicare Part A and B. This is essentially just additional details on the cost-saving stuff in section 3201. Also a lot of numbers talk regarding Medicare Advantage rebates. Adjustment of costs for Medicare Advantage services continues on a yearly basis (prior to HCERA, it only continued until 2010). For the first 45 days of the year, people enrolled in Medicare Advantage can choose to change their plan to a standard Medicare plan. Extends the Medicare Advantage Special Needs Program through 2014, as well as listing a lot of requirements that these plans would need to meet. Renews until January 1, 2013 the ability for Medicare recipients to obtain Reasonable Cost Contracts. Secretary of HHS is to extend service area waivers for Medicare Advantage plans for providers who contracted with the Secretary for those waivers prior to Oct. 1, 2009. Makes permanent senior housing facilities created under a specific demonstration project as of December 31, 2009. 2011 2011

3141

3142

2011

3143 3201

3202

3203

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

3204

3205

2010-2014

3206

2010-2013

3207

3208

Amends the Social Security Act

3209

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

Clarifies that the Secretary of HHS has the right to reject bids for plans by a Medicare Advantage organization, and bids for plans by a Prescription Drug Plan sponsor, if those plans propose significant increases to costs or reductions to service. Directs the Secretary of HHS to request the National Association of Insurance Commissioners to revise standards for supplemental Medicare benefit plans. Any drug companies wanting to continue to work with Medicare Part D must participate in the Medicare Coverage Gap Discount Program outlined in this section. It outlines the actual Medicare Coverage Gap Discount Program, which was set to start at the same time (January 1, 2011). This section addresses the infamous "Donut Hole" in coverage, which plagued Medicare recipients who purchased enough drugs to surpass the prescription drug coverage limit, but not enough to qualify for catastrophic coverage. It does so by making the drug companies that work with Medicare give discounts to those who fall within that gap. The low-income benefit for Medicare part is calculated without taking into consideration discounts and rebates received under Medicare Advantage. This way, those getting discounts like that won't be penalized for it when purchasing drugs. Secretary of HHS can allow a prescription drug plan to charge low-income beneficiaries the low-income subsidy if the plan's premium is more expensive than the low-income subsidy plus a "de minimis" amount. This section deals with widows and widowers on low-income assistance. Normally, Centers for Medicare and Medicaid Services check beneficiaries' financial status on a regular basis to make sure they still qualify for low-income programs, and if someone is making too much money in a given timeframe, they may no longer qualify as "low income". However, when someone's wife or husband dies, they surviving spouse generally inherits their significant others' stuff. This section says that that check on beneficiaries' status can not happen within a year of the death of a spouse, so someone isn't dropped from Medicare or Medicaid just because they lost a loved one. When the Secretary of HHR reassigns someone to a different Medicare drug plan (apparently due to a change in their economic status), they are to be informed of the differences between their old plan and the new one, as well as being informed of their right to request a coverage determination, exception, or reconsideration. 2011

3210

3301

3302

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

3303

2011

3304

2011

3305

Amends the Social Security Act

2011

3306

Amends the Medicare Improvement s for Patients and Providers Act of 2008

Designates an additional $15,000,000 be set aside to fund the State Health Insurance Program from 2010 through 2012, an additional $15,000,000 be set aside to fund Aging and Disability Resource Centers from 2010 through 2012, an additional $5,000,000 be set aside to fund a contract with the National Center for Benefits and Outreach Enrollment from 2010 through 2012. The Secretary of HHS can request support from the entities funded by this section for wellness and disease prevention outreach programs. Medicate Advantage insurance companies must include coverage for specific categories of drugs designated by the Secretary of HHS. Until the secretary designates which drugs are to be covered, these categories are to include anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants for the treatment of transplant rejection. If you make over $80,000 ($160,000 for couples filing taxes jointly), your Medicare Part D monthly costs will increase in a fashion similar to Medicare Part B. This amount will be taken out of your social security. On a date no earlier than January 1, 2012, if you're eligible for both Medicare and Medicaid, and receiving home or community-based services instead of going to a hospital, you cannot also qualify for cost-sharing under Medicare Part D. Drug plans for patients in long-term care facilities must be more efficiently managed and drugs given to patients must be dispensed in a more efficient manner, using uniform dispensing techniques, to reduce waste. Directs the Secretary of HHS to create and maintain a complaint system, to be made available on Medicare.gov, and the Secretary shall report yearly to Congress on this system. (http://medicare.gov/claims-and-appeals/file-acomplaint/complaints.html) Makes a standard and uniform appeals process for those who feel their claim should not have been denied. Directs the Inspector General of the Dept. of HHS to conduct a study about the type of drugs used by those in Medicare Advantage plans, which the Secretary of HHR is to present to Congress no later than July 1 every year starting in 2011. The Inspector General is also to conduct a study on the 200 most frequently-used Medicare Part D drugs and their pricing under both normal Medicare and Medicare Advantage. That report is to be given to Congress no later than October 1, 2011. Drugs paid by AIDS drug programs and Indian Health Services count towards calculations for determining qualification for Medicare Part D catastrophic care.

2010-2012

3307

Amends the Social Security Act

2011

3308

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

2011

3309

2012 (?)

3310

3311

2010

3312 3313

Amends the Social Security Act

2012 2011

3314

Amends the Social Security Act

2011

3315

Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act Amends the Social Security Act

Gives a $250 rebate to Medicare recipients who fall into that "donut hole" that mentioned in Section 3301. It's only in effect for one year. Reduces the increases in payments that many various types of medical facilities and services were going to be getting through Medicare. From Jan. 1, 2011 through Dec. 31, 2019, income thresholds for Medicare Part B will be frozen at their 2010 levels, rather than being tied to inflation like they previously had been. Creates the Independent Medicare Advisory Board. The board is to be comprised of 15 experts (who cannot hold any other employment while they are part of the board, so there's no conflict of interest) who are appointed by the President with the advice and consent of the Senate, as well as the Secretary of HHS, the Administrator of the Center for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration, who will be nonvoting members. The presidential appointees serve 6-year nonconsecutive terms. The board's purpose is to reduce Medicare spending per person by submitting proposals to be enacted by the Secretary unless Congress says otherwise. These proposals must cut costs, must not ration health care, and must not increase costs to Medicare recipients, must not cut Medicare benefits, and must not modify eligibility criteria. Directs the Director of the Agency for Healthcare Research and Quality to research, create, and to put into practice quality improvement practices and create training for those practices, and to and to this end it directs the Director to establish The Center for Quality Improvement and Patient Safety of AHRQ. This section sets aside $20,000,000 for 2010 though 2014 to be put towards carrying out this section. Directs the Director of the Agency for Healthcare Research and Quality to give out grants to health providers that need financial help meeting the quality improvement measures mentioned in Section 933. Recipients of these grants need to match every $5 of funds they receive with $1 of their own. Directs the Secretary of HHS to establish a program to provide grants for community-based "health teams" to support primary care providers. These "health teams" need to have a plan to be self-sustaining within three years. P/x: Creates a communitybased support system of professionals so primary care doctors have specialists to refer patients to. Directs the Secretary of HHS to establish a program to provide grants to implement medication management services for the treatment of chronic diseases.

2010

3401

3402

3403

3501

Adds section 933 to the Public Health Service Act

3501

Adds section 934 to the Public Health Service Act

3502

3503

Adds section 935 to the Public Health Service Act

2010

3504

Adds section 1204 to the Public Health Service Act Adds section 498D to the Public Health Service Act Amends the Public Health Services Act Adds section 1245 to the Public Health Service Act Adds section 1246 to the Public Health Service Act Adds section 1281 to the Public Health Service Act Adds section 1282 to the Public Health Service Act Adds section 936 to the Public Health Service Act

3504

Directs the Secretary of HHR to award at least 4 multi-year contracts to states that support pilot projects to test innovative new ways to do regional emergency care. States have to match every $3 of funds they receive with $1 of their own. Within 90 days of completing a pilot project, states are to report to the Secretary about it. Directs the Secretary of HHR to support research of various government agencies in emergency medical care systems and emergency medicine. Directs the Secretary of HHS to establish 3 programs to award grants to Indian health facilities. The Secretary may also award grants to certain low-income trauma centers. It goes into detail as to what sort of trauma centers can get the grants and what sort of grants they can get. Sets aside $100,000,000 to pay for the previous section in 2009, and "such sums as may be necessary" from 2010 through 2015. Clarifies what "uncompensated care costs" means.

3505

3505

2009-2015

3505

3505

Allows states to award grants to create or strengthen trauma centers. Sets aside $600,000,000 to pay for the previous section in 2010 though 2015. Directs the Secretary of HHS to create a program to provide grants for the development of "Patient Decision Aids," materials to help patients and doctors to better know what their options are when there is a choice regarding different forms of treatment. These materials are to be made freely available. Directs the Secretary of HHS to conduct a study to determine whether health care decision-making would be improved by standardizing the way drug information is presented on prescription drugs. This study is to be done by 2011, and if it is determined that it would be improved, within 3 years the Secretary is to create regulation to enact that standardization. 2010-2015

3505

3506

3507

2011

3508

3509

Adds section 229 to the Public Health Service Act

3509

Adds section 310A to the Public Health Service Act Adds section 925 to the Public Health Service Act Adds section 713 to the Social Security Act

3509

Directs the Secretary of HHS to award grants for demonstration projects to medical schools that incorporate quality improvement and patient safety into their curriculum. Schools can submit proposals and, the Secretary decides if it's worth trying, and the school tracks data on the new curriculum's results. For every $5 of grant money a school gets for this, the school must contribute $1 themselves. By 2012, the Secretary is to start submitting a yearly report to Congress on what demonstration projects are underway and how well they're doing. Establishes an Office on Women's Health under the Secretary of HHS, to be headed by a Deputy Assistant Secretary for Womens Health. This office is intended to advise the Secretary on issues relating to women's health, as well as to establish the National Womens Health Information Center, which is to assist with providing information regarding issues that effect women's health. By 2011, the Secretary is to submit reports to Congress every other year detailing the activities carried out under this section. The Office on Women's Health is to take over the functions previously belonging to the Office on Womens Health of the Public Health Service. Establishes an Office on Women's Health under the Office of the Director of the Centers for Disease Control and Prevention, headed by a director appointed by the Director. This office is intended to advise the Director on issues relating to women's health. Establishes an Office on Women's Health and Gender-Based Research under the Office of the Director of the Agency for Healthcare Research and Quality. This office is intended to advise the Director on issues relating to women's health. Directs the Secretary of HHS to establish an Office on Women's Health under the Office of the Administrator of the Health Resources and Services Administration. This office is intended to advise the Administrator on issues relating to women's health, and to take over any Health Resources and Services Administration programs relating to womens health. Establishes an Office on Women's Health under the Commissioner of Food and Drugs, headed by a director appointed by the Director. This office is intended to advise the Commissioner on issues relating to women's health. This section also clarifies numerous limitations that this office can't do. Extends from 2010 through 2014 the "Patient Navigator Program." This is essentially extending a program to help patients find the services they need. (http://www.altfutures.com/draproject/pdfs/Report_07_02_Pati ent_Navigator_Program_Overview.pdf)

2012

2011

3509

3509

Adds section 1011 to the Federal Food, Drug, & Cosmetic Act Amends the Public Health Services Act

3510

3511 3601

Authorizes the Secretary of HHS to appropriate funds for this part of the bill. Says nothing in this bill will reduce guaranteed Medicare benefits, and any savings this bill makes to Medicare will be reinvested back into Medicare to extend its solvency, reduce its premiums, or increase its benefits. Says "nothing in this Act shall result in the reduction or elimination of any benefits guaranteed by law to participants in Medicare Advantage plans."

3602

APPENDIX D: Title IX (Revenue Provisions) PPACA 9001 9002 Codification Adds section 4980I to IRC Adds paragraph to section 6051(a) of IRC Amends sections 106, 220, and 223 of IRC Amends sections 220 and 223 of IRC Amends section 125 of IRC Amends section 6041 of IRC Amends sections 501 and 6033 of IRC Refers to section 275(a)(6) of IRC Refers to section 275(a)(6) of IRC Refers to section 275(a)(6) of IRC Description 40% excise tax on employer sponsored health coverage above a threshold. Must include aggregate cost of employer-sponsored health coverage on annual Form W-2 for employees Effective Date 2018 2011

9003

The definition of qualified medical expense for HSAs, FSAs, and HRAs is amended to exclude over-the-counter medicine unless obtained with a prescription or is insulin. Increase in additional tax on distributions from HSAs not used for qualified medical expenses to 20% Limits FSA contributions to $2,500 (indexed in future years).

2011

9004

2011

9005 + 10902 (RECON) 9006 9007

2013

Expands information reporting requirements on 1099. Additional reporting requirements for charitable hospitals

Repealed 2010

9008

Flat annual fee imposed on branded prescription drug sales to specified government programs Flat annual fee imposed on medical device manufacturers.

2010

9009 + 10904 (RECON) 9010

2010

Flat annual fee on non-government health insurers based on market share. $8 billion in 2014, $11.3 billion in 2015 and 2016; $13.9 billion 2017; $14.3 billion in 2018; increased by rate of premium growth thereafter. Amended to exempt any non-profit entity incorporated under State law or any entity described in section 501(c)(4) that provides commercial-type insurance, if their premiums are regulated by a State authority... (i.e. Exemption for Exchanges?) Eliminates deduction for expenses allocable to Medicare Part D subsidy.

2014

9012

Amends section 139A of IRC

2013

9013

9014

Amends sections 213 and 56 of IRC Amends section 162(m) of IRC Amends section 164, 3101, and 3202 of IRC Amends section 833(c) of IRC Amends section 5000B of IRC Amends section 139D of IRC Amends section 125 of IRC Amends sections 46, 48D, 49(a), & 280C(g) Amends sections 1411 and 6654 of IRC Adds to scattered sections of IRC

Raises floor on medical expense deduction to 10% of AGI. (after 2017 for seniors). Limitation on excessive remuneration paid by certain health insurance providers. Applies $500,000 deduction limit for current and deferred compensation paid to officers, directors, employees, and service providers of health insurers for taxable years beginning after 2012 with respect to services performed after 2009. Additional 0.9% Hospital Insurance Tax under FICA on highincome taxpayers making over $200,000 a year (or $250 if filing jointly). Health organizations with medical loss ratios below 85% don't qualify for same tax treatment as BCBS organizations. Imposes a 10% tax on the amount paid for indoor tanning services on individual in which the services are performed. Health benefits provided by Indian tribal governments are excluded from gross income. Small employers (employed an average of 100 or fewer employees on business days during either of the two preceding years) can establish "simple cafeteria plan." Self-employed individuals may be counted as qualified employees. 50% credit is provided to small businesses (companies having 250 or fewer employees) for certain medical investments made in tax years beginning in 2009 and 2010. SUBSEQUENT AMENDMENTS Imposes a new 3.8 percent tax on the lesser of net investment income or the excess of modified AGI over $200,000 (or $250,000 if filing jointly). Codification of the economic substance doctrine (defined under section 7701(o) of IRC); imposes new strict liability penalty for underpayments attributable to transactions lacking economic substance (under section 6662 of IRC). The penalty rate is 20%, increased to 40% if the taxpayer does not adequately disclose the relevant facts affecting the tax treatment in the return or a statement attached to the return. Increases quarterly estimated tax due in July, August, or September 2014 by 15.75 percentage points.

2013

2010

9015 + 10906 (RECON) 9016

2013

2010

9017 + 10107 (RECON) 9021 9022

2010

2010 2011

9023

2009

1402

2013

1409

Applies to t/a entered into after Mar. 30, 2010

1410

2010