Analysis of the Health Care Reform Law: PPACA and the Reconciliation Act – Part

ANALYSIS OF THE HEALTH CARE REFORM LAW: PPACA AND THE RECONCILIATION ACT
 
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). On March 30, 2010, the Health Care and Education Reconciliation Act was enacted, the reconciliation law that made changes to the PPACA. After 18 months of legislative activity, preceded by decades of fits and starts, a major step forward was taken in reforming the country?s health care system. Health care reform offers coverage for the majority of uninsured individuals in the United States and eventually will add up to 16 million individuals to the Medicaid program.
 
The National Health Law Program (NHeLP) analysis includes the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148) as well as the amendments made to PPACA by the Health Care and Education Reconciliation Act (Recon. Act, P.L. 111-152). For those of you who are looking for an integrated version of the PPACA, including the Manager?s Amendment and theReconciliation Act, an unofficial version is available at http://s3.amazonaws.com/thf_media/2010/pdf/ppacaconsolidated.pdf.
NHeLP has undertaken a comprehensive analysis ofthese laws. Given NHeLP?s focus on Medicaid and CHIP, civil rights, reproductive health and justice, and empowering low-income beneficiaries and their advocates, we have concentrated our analysis on areas of the law most related to those areas and populations.
 
The Table of Contents identifies the sections that have been analyzed. In addition to this broad analysis, NHeLP will release more in-depth analyses on specific topics. We anticipate that these focused stand-alone analyses will covertopics such as Medicaid, children?s health, health care disparities, reproductive health and health care for immigrants. 
The analysis primarily focuses on Titles I and II of the law. We have divided the document into three parts:
 
  • Part Iincludes an analysis of PPACA Title I, covering the private insurance reforms and statebased exchanges; 
  • Part IIincludes an analysis of PPACA Title II, covering changes to the Medicaid program; and
  • Part III analyzes selected provisions from Titles III, IV, VI, XIII and IX.
Notes

 
When reading this analysis, ?Secretary? generally refers to the Secretary of the Department of Health and Human Services, unless specifically noted otherwise.
A few other notes and abbreviations are relevant to this analysis:
Abbreviations of Laws:
  • SSA refers to the Social Security Act
  • PHSA refers to the Public Health Service Act, 42 U.S.C. § 300gg etseq.
  • DRA refers to the Deficit Reduction Act
  • CHIPRA refers to the Children?s Health Insurance Program Reauthorization Act
  • IRC refers to the Internal Revenue Code of 1986
     
Abbreviation of Terms:
  • FMAP refers to the Federal Medical Assistance Percentage
  • FPL refers to the Federal Poverty Level
  • LIS refers to the Low Income Subsidy for Medicare Part D
Abbreviation of Federal Agencies or other Organizations:
  • DHS ? Department of Homeland Security
  • SSA ? Social Security Administration
  • Treasury ? Department of the Treasury
  • NAIC ? National Association of Insurance Commissioners
We have generally included effective dates for each section. However, it is important to recognize that many provisions will not be implemented without appropriations. Thus, the appropriations process is critical to ensuring that many of the Act?s important provisions can be implemented.
If you have any questions about the analysis or need further information, please call NHeLP at (202) 289-7661, or e-mail Mara Youdelman at Youdelman@healthlaw.org.
And finally, much thanks to the NHeLP staff ? in particular Mara Youdelman ? who worked tirelessly to complete this analysis:
Randy Boyle, Senior Attorney
Leonardo Cuello, Staff Attorney
Susan Berke Fogel, Senior Attorney
Lorraine Jones, Senior Attorney
Manju Kulkarni, Senior Attorney
Jane Perkins, Legal Director
Patti Riippa, Communications Director
Deborah Reid, Senior Attorney
Sarah Somers, Senior Attorney
Sarah Lichtman Spector, Staff Attorney
Doreena Wong, Senior Attorney
Mara Youdelman, Senior Attorney
We hope you find this analysis useful.
Emily Spitzer
Executive Director

TITLE III?IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
 
Only the following sections are analyzed
 
Subtitle A?Transforming the Health Care Delivery System
 
PART II?NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
 
Sec. 3011. National strategy.
 
PART III?ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
 
Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within CMS.
Sec. 3022. Medicare shared savings program.
Sec. 3023. National pilot program on payment bundling.
Sec. 3024. Independence at home demonstration program.
Sec. 3025. Hospital readmissions reduction program.
Sec. 3026. Community-Based Care Transitions Program.
Sec. 3027. Extension of gainsharing demonstration.
Subtitle B?Improving Medicare for Patients and Providers
 
PART III?IMPROVING PAYMENT ACCURACY
 
Subtitle C?Provisions Relating to Part C
 
Sec. 3201. Medicare Advantage payment.
Sec. 3202. Benefit protection and simplification.
Sec. 3203. Application of coding intensity adjustment during MA payment transition.
Sec. 3204. Simplification of annual beneficiary election periods.
Sec. 3205. Extension for specialized MA plans for special needs individuals.
Sec. 3206. Extension of reasonable cost contracts.
Sec. 3207. Technical correction to MA private fee-for-service plans.
Sec. 3208. Making senior housing facility demonstration permanent.
Sec. 3209. Authority to deny plan bids.
Sec. 3210. Development of new standards for certain Medigap plans.
 
Subtitle D?Medicare Part D Improvements for Prescription Drug Plans and MA?PD Plans
 
Sec. 3301. Medicare coverage gap discount program.
Sec. 3302. Improvement in determination of Medicare part D low-income benchmark premium.
Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under prescription drug plans and MA?PD plans.
Sec. 3304. Special rule for widows and widowers regarding eligibility for low-income assistance.

TITLE III?IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
 
Only the following sections are analyzed
 
Subtitle A?Transforming the Health Care Delivery System
 
PART II?NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
 
Sec. 3011. National strategy.
 
PART III?ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
 
Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within CMS.
Sec. 3022. Medicare shared savings program.
Sec. 3023. National pilot program on payment bundling.
Sec. 3024. Independence at home demonstration program.
Sec. 3025. Hospital readmissions reduction program.
Sec. 3026. Community-Based Care Transitions Program.
Sec. 3027. Extension of gainsharing demonstration.
Subtitle B?Improving Medicare for Patients and Providers
 
PART III?IMPROVING PAYMENT ACCURACY
 
Subtitle C?Provisions Relating to Part C
 
Sec. 3201. Medicare Advantage payment.
Sec. 3202. Benefit protection and simplification.
Sec. 3203. Application of coding intensity adjustment during MA payment transition.
Sec. 3204. Simplification of annual beneficiary election periods.
Sec. 3205. Extension for specialized MA plans for special needs individuals.
Sec. 3206. Extension of reasonable cost contracts.
Sec. 3207. Technical correction to MA private fee-for-service plans.
Sec. 3208. Making senior housing facility demonstration permanent.
Sec. 3209. Authority to deny plan bids.
Sec. 3210. Development of new standards for certain Medigap plans.
 
Subtitle D?Medicare Part D Improvements for Prescription Drug Plans and MA?PD Plans
 
Sec. 3301. Medicare coverage gap discount program.
Sec. 3302. Improvement in determination of Medicare part D low-income benchmark premium.
Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under prescription drug plans and MA?PD plans.
Sec. 3304. Special rule for widows and widowers regarding eligibility for low-income assistance.

Sec. 4106. Improving access to preventive services for eligible adults in Medicaid.
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant women in Medicaid.
Sec. 4108. Incentives for prevention of chronic diseases in Medicaid.
 
Subtitle C?Creating Healthier Communities
 
Sec. 4201. Community transformation grants.
Sec. 4202. Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries.
Sec. 4203. Removing barriers and improving access to wellness for individuals with disabilities.
Sec. 4204. Immunizations.
Sec. 4205. Nutrition labeling of standard menu items at chain restaurants. Not analyzed.
Sec. 4206. Demonstration project concerning individualized wellness plan. Not analyzed.
Sec. 4207. Reasonable break time for nursing mothers.
 
Subtitle D?Support for Prevention and Public Health Innovation
 
Sec. 4301. Research on optimizing the delivery of public health services. Not analyzed.
Sec. 4302. Understanding health disparities: data collection and analysis.
Sec. 4303. CDC and employer-based wellness programs. Not analyzed.
Sec. 4304. Epidemiology-Laboratory Capacity Grants. Not analyzed.
Sec. 4305. Advancing research and treatment for pain care management. Not analyzed.
Sec. 4306. Funding for Childhood Obesity Demonstration Project. Not analyzed.
 
Subtitle E?Miscellaneous Provisions
 
Not analyzed.
 
TITLE V?HEALTH CARE WORKFORCE
 
Not analyzed
 
TITLE VI?TRANSPARENCY AND PROGRAM INTEGRITY
 
Only the following sections are analyzed
 
Subtitle D?Patient-Centered Outcomes Research
 
Sec. 6301. Patient-Centered Outcomes Research.
Sec. 6302. Federal coordinating council for comparative effectiveness research.
 
Subtitle E?Medicare, Medicaid, and CHIP Program Integrity Provisions

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