Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
-
Upload
maria-tortilla -
Category
Documents
-
view
215 -
download
0
Transcript of Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
1/31
APPENDIX A: Title I (Individual & Group Market Reforms)
PPACA Codification DescriptionEffective
Date
1001
Adds section
2711 to thePublic HealthServices Act
Insurers cannot have lifetime limits on the amount of carecustomers can get and can't have yearly limits either.
2010
1001
Adds section2712 to the
Public Health
Services Act
No more "rescissions." Insurers cannot drop customers once
they get sick. The only time they can drop a customer is if thatcustomer commits fraud.
2010
1001
Adds section
2713 to thePublic HealthServices Act
Insurance plans need to include preventive care
(colonoscopies, mammograms, immunizations, etc.) withoutany extra costs (like co-pays). I should note that this sectionalso includes something that led to a bit of controversy - It says
that health insurance must include preventive care for womensupported by the Health Resources and ServicesAdministration. And the Health Resources and ServicesAdministration, on the recommendation of the independent
Institute of Medicine of the National Academy of Science, hasdetermined that preventive care for women should include
access to, amongst other things, contraception. Insurers
must provide these services, and cannot require a co-pay forthem.
2010
1001
Adds section2714 to thePublic Health
Services Act
Insurance plans need to coverdependents up to the age of 26. 2010
1001
Adds section
2715 to thePublic HealthServices Act
Insurers and plan sponsors ofself-funded plans must provide
summary of benefits to all participants and applicants, based on
format set by Secretary, using uniform definitions and statingwhether the plan provides minimum essential coverage andwhether ensures the plan's share of costs is at least 60% of
actuarial value.
2012
10101RECON
Adds section
2715A to thePublic Health
Services Act
Adds that "except that a plan or coverage that is not offeredthrough 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 thepublic" undersection 1311(e)(3).
10101RECON
Adds section
2716 to thePublic HealthServices Act
Group health plans ("other than a self-insured plan") mustabide by section 105(h)(2) of IRC prohibition on discriminationin favor of highly compensated individuals.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
2/31
1001 +
10101
RECON
Adds section
2718 to thePublic Health
Services Act
Insurance companies need to make public how much theyspend 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 sendrebates out to their customers.
2011
1001
Adds section2719 to the
Public HealthServices Act
Insurers need to offer customers the ability to appeal a claimthat was denied. This appeal process will be monitored under
an external review process to make sure it's doing what it'ssupposed to.
2010
1001 +10101
RECON
Adds section
2719A to thePublic HealthServices Act
Makes sure that insured customers can decide their own
OB/GYN and Pediatrician as Primary Care Provider, and that iftheir insurance covers emergency care, customers can go to any
emergency room without having to worry whether their
insurance will cover that specific emergency room.
2010
1002
Adds section
2793 to thePublic HealthServices Act
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 tospread information, answer questions, and help to facilitate
appeals processes.
2010
1003
Adds section
2794 to the
Public HealthServices Act
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. Insurersmust explain their reasons for any such unreasonable
increases before making them, and must make this informationavailable to the public. If any insurer increases premiums toomuch or too fast, it may be dropped from "exchange" programs.
2010
1101The 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.
2010-
2014
1102
Establish for establishment of another temporary program toreimbursement 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.
2010-
2014
1103Amends thePublic Health
Services Act
Create a website to help people find health insurance in theirstate, and give them information about options available to
them. (http://www.healthcare.gov/)
2010
1104New "administrative simplification" standards for the electronicexchange of information to simplify and reduce the paperworkand clerical burden on patients, providers, and insurers.
2013
1201
Adds section
2704 to the
Public HealthServices Act
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
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
3/31
1201 +
10103RECON
Adds section2701 to the
Public Health
Services Act
The only things about you that insurers can take intoconsideration when determining your premium rates are
whether you want to cover your family or just you, what yourage is, whether or not you use tobacco, and other factors to be
determined by each state (unless the Secretary of HHS believesa state's "rating area" to be inadequate, in which that rating area
may be changed).Amended to insert "(other than self-insuredgroup health plans offered in such market)" after "suchmarket."
2014
1201
Adds section
2702 to thePublic Health
Services Act
Insurers must accept everyone who applies for coverage. 2014
1201
Adds section2703 to the
Public Health
Services Act
Insurers must renew coverage for everyone who has it. 2014
1201
Adds section2705 to the
Public Health
Services Act
Insurers can't restrict you from getting a plan based on pastillnesses, genetic history, a disability, previous health careyou'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.
2014
1201
Adds section
2706 to the
Public HealthServices Act
If a doctor or hospital is willing to work with an insurer, the
insurer has to let them.2014
1201
Adds section2707 to the
Public Health
Services Act
Reiterating that all plans offered must cover the stuff specified
by the other sections of this bill. 2014
1201 +10103RECON
Adds section2708 to thePublic Health
Services Act
Waiting periods can't be longer than 90 days.Amended to strike
"or individual."2014
1201 +
10103
RECON
Adds section
2709 to thePublic Health
Services Act
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 toparticipate in one.
2014
1251Says that when this law passed, no one had to change theirplans. They could if they wanted, but they could totally keeptheir current plan if they like it.
2014
1252Says that the changes this law makes apply to all health planscompanies offer, not just some.
2014
1253 +10103RECON
The Secretary of Labor needs to make a yearly report toCongress on self-insured employers.
2011
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
4/31
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
5/31
1311
Provides that states must establish exchanges or leave to federal
government. This section sets aside money to the states so theycan 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 toget their act together, though - after that they get no money.
However, states must have something ready by 2014. Statescan choose to require insurers to have benefits that go above
and beyond what this law requires, but they have to figure outhow to pay for anything they come up with that requires moregovernment money. By 2015, the exchanges need to be self-
funding. States can even team up to make multi-state exchangesif they want.
2010
1312
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 permitlarge employers to purchase coverage through Exchanges.
2014
1313
States need to keep track of the money these insurance
exchanges are using, make sure they're working rightfinancially, and watch out for fraud.
2014
1321
The Secretary of HHS is to set the standards that theseinsurance exchanges are supposed to follow. If any state fails tofollow 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.
2014
1322
Amends
sections ofIRC
This sets up the rules, as well as instructions for loans and
grants, for the creation of non-profit, member-run insurerscalled Co-ops.
Repealed.
See H.R.1473.
1323Allocates money specifically for territories that aren't states,
like Puerto Rico.
1324This says that Co-ops have to work under the same laws asnormal insurance companies.
1331
This allows thegovernmentto create a low-cost insuranceoption for people who make too much money to qualify for
Medicaid, but who still make less than 200% of the povertyline (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).
2014
1332
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 theycan 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.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
6/31
1333States can work with insurers to allow them to make plans
available in multiple states with different laws and regulations2013
1334 +10104
RECON
Provides for the establishment ofmulti-state plans and givesthe Director of OPM the power to enter into contracts with
insurers to offer multi-state plans through an Exchange.
1341
States must either create or work w/an already-existing non-
profit reinsurance agency. Reinsurance agencies buyinsurance plans from insurers when they are deemed to be high-
risk. This helps to keep premiums for other customers down,
since otherwise insurers would have to raise prices to offset thatrisk. This section talks about some of the rules for these sorts ofagencies. 50-100 medical conditions are to be identified as
high-risk conditions that insurers can offer up to reinsuranceagencies. Partly to offset the risk these agencies are taking by
taking on these high-risk customers, reinsurers are tax-exempt.
2014-2016
1342
The government will create "Risk corridors" for individual
and small group markets. Essentially, in the first two yearswhile insurers adjust to all these new rules going into effect in
2014, the government will help with some of the risk associatedwith insurance payouts.
2014-
2016
1343
Each state will charge insurers who take on less risk, and makepayments 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.
1401(a)
Adds
sections 36B
and 280C(g)to IRC
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 manypeople are in your household). A refundable tax credit is
basically a discount on your taxes, and if it's more money thanyou pay in taxes, you actually get the extra money back as a
refund.
2014
1402
Insurers must reduce costs for everyone who makes too muchto qualify for Medicaid, but makes less than 400% of the
poverty line. Depending on how much you make, your co-paycosts could be slashed by up to two-thirds the normal price, and
your overall costs could be covered up to 94%. If you're anAmerican Indian making under 300% of the poverty line, you
have no co-pay. This section specifically says it only applies tocitizens and legal aliens living in the US (so no illegal aliens
allowed).
2014
1411
Instructs the Secretary of HHS to set up a way to check whetherpeople are eligible to buy insurance. It looks like it's basically,
in a roundabout way, trying to keep illegal aliens from beingqualified for insurance, and setting up penalties for anyone wholies on insurance forms.
1412
This section instructs the Secretary of HHS to set up a way to
check whether people are eligible for the tax credits and theinsurance 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.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
7/31
1413Amendssections ofIRC
This section instructs the Secretary of HHS to set up standardforms and enrollment procedures for state-level programs likeMedicaid and Child Health programs.
1414
Amends
sections 6103and 7213 ofIRC
The Secretary of HHS is allowed to share relevant taxinformation with those who need it in order to verify what
people qualify for.
1415Amendssection 36Bof IRC
All these tax credits and refunds won't count as income. Sothey won't be taxed or anything.
1416
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).
1421(b)Adds tosection 38 of
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 andallow against alternative minimum tax.
2010-
2013
1421(a)Adds section45R to IRC
Small Businesses are eligible for a tax credit worth up to 50%of the cost of the health care they provide their employees.
2014-2016
1501(a)
Adds section
50A to IRC
This is a lengthy explanation for the reasons behind the"individual mandate." The basic theory is, without it, peoplemight 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. Theeconomy loses a ton of money due to uninsured people needingemergency 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 introduceseven 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 healthypeople who have insurance, the less of a risk insurers are
taking, which lowers everyone's prices.
2014
1501(b)
Adds section
5000A toIRC
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 behit 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% ofincome, by 2016. This section makes an exception for thosewith 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.
2014
1502(a)Adds section
6055 to IRC
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 throughtoo. Provides for assessable penalties for failing to report.
2015
(delayed)
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
8/31
1511
Adds section
18A to FairLabor
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 ifthey don't want it.
2010 (but
awaitingIRS
regulation
s)
1512
Adds section18B to Fair
LaborStandardsAct of 1938
Employers must provide written notice informing employeesabout their options with health insurance exchanges and
potential eligibility premium tax credits if the employer's shareof costs is less than 60% of the allowed total cost of benefits.
2013
1513Adds section4980H toIRC
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-timeemployees they'd represent (in other words, it's not a simple
head count). The Secretary of Labor is to conduct a report tosee what effect this has on employees' wages.
2014
1514(a)Adds section
6056 to IRC
Employers need to report to the Secretary of Health and Human
Resources about the insurance being used by the employeesworking for them.
2015
(delayed)
1515
Amends
section
125(f) of IRC
You cannot get a "cafeteria plan" using an insurance exchange
(a plan where you specifically pick what is and isn't covered).2014
1551Amends thePublic Health
Services Act
Says that this part of the bill uses the same definitions as thePublic Health Service Act.
1552
Amends the
Public Health
Services 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.
2010
1553
Amends the
Public HealthServices Act
The Federal Government, States, and insurers cannot
discriminate against doctors and hospitals that refuse to doassisted suicide.
1554Amends thePublic Health
Services Act
The Secretary of Health and Human Services will not promoteregulation that limits peoples' ability to get health care, or limits
doctors' ability to communicate with patients.
1555
Amends the
Public Health
Services Act
Any Federal Health Insurance Programs created by this act are
optional (anything like Medicare and Medicaid, for example).
No one has to join them.
1556
Amends
Black LungBenefits Act
Extends date to cover recent issues involving health problems
suffered by coal miners.
1557Amends thePublic Health
Services Act
Health insurance programs benefiting from Federal credits andsubsidies cannot discriminate against anyone based on age,
gender, race, etc.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
9/31
1558
Adds section
18C to theFair Labor
StandardsAct of 1938
Employers can't discriminate against employees that havereceived tax credits.
2010(effectivel
y 2014)
1559
Amends the
Public Health
Services Act
The Inspector General of the Dept. of HHS is in charge of
administration and implementation of this law, as it pertains to
his department.
1560Amends thePublic HealthServices Act
States that "nothing in this title shall be construed to modify orsupersede 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 agencyresponsible for determining eligibility for programs identified
in section 1413."
1561
Amends
section 3021
of the PublicHealthServices Act
180 days after this bill was passed, a couple of Health
Information Technology committees will work to startspreading information and helping people enroll in HHS
programs.
1562 +10107
RECON
The Comptroller General of the US is directed to conduct astudy on the denial of coverage; details how he's to go about
doing it.
2011
1563
Amends the
Public Health
Services Act
Makes many small changes include slight alterations and
rewordings, additional definitions of terms, and language that
fits in better with this bill.
1563
Amendssection 715
of theEmployee
RetirementIncomeSecurity Act
Adds that the rules in that document apply to group insuranceplans as well as individual insurance plans. States that sections
2716 and 2718 (as amended by this Act) shall not apply to self-insured group health plans.
1563Adds section
9815 to IRC
Adds that the rules in that document apply to group insuranceplans as well as individual insurance plans. States that sections
2716 and 2718 (as amended by this Act) shall not apply to self-insured group health plans.
1564
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 andnot folded back into the PPACA.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
10/31
APPENDIX B: Title II (Role of Public Programs)
PPACA Codification DescriptionEffective
Date
2001
Amends the
Social
Security Act
Everyone up to 133% of the poverty line is covered byMedicaid. 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 thisprovision will increase the number of people who qualify forMedicaid in 2014. This section also increases federal funding to
support the increase. However, it should be mentioned that theSupreme Court has made it clear that individual states could opt
not to do this. However, in Justice Roberts' opinion "Congressmay offer the States grants and require the States to comply
with accompanying conditions, but the States must have agenuine choice whether to accept the offer." In other words,
States can't be forced to do this, but they can be givenincentives to do this.
2014
2004Amends theSocialSecurity Act
Medicaid will cover former foster children under the age of 26. 2014
2005Increases the amount of Medicare money given to USTerritories.
2006Amends theSocialSecurity Act
It apparently increases the amount of Federal money given formedical care when there is a major disaster.
2011
2007
Between 2014 and 2018, this cuts about $700,000,000 from a
part of Medicaid called the Medicaid Improvement Fund, ayearly fund established to improve the management ofMedicaid. This provision was created to help fund this bill,
which itself tries to improve Medicaid (along with everything
else).
2014
2101Amends theSocialSecurity Act
Between October 2005 and September 2009, the amount ofmoney allocated to the Children's Health Insurance Program
(CHIP) increases, and this section says that states that want toget this increased funding need to make sure that the healthinsurance provided under CHIP meets the same standards as
those in this bill.
2201
Adds section
1943 to theSocial
Security Act
This calls for the creation of a website for people who use
Medicaid and CHIP to sign up for and renew insurance plansusing their state's insurance exchanges.
2202Amends theSocial
Security Act
Apparently allows a hospital to choose whether they want to be
able to make a determination whether or not a patient iscovered under Medicaid. I'm just guessing here, but I think that
this is to streamline things and make it easier for hospitals tosign patients up for Medicaid if a patient looks like they might
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
11/31
qualify for Medicaid.
2301
Amends the
SocialSecurity 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.
2302Amends theSocialSecurity Act
if a child has been diagnosed with a terminal illness, and the
parents have chosen to pay for hospice care, that paying forhospice care doesn't mean that they are giving up any otherforms of care that Medicaid and CHIP might provide for their
child as well
2303
Amends the
SocialSecurity Act
Provide those with a low income (an amount which is to bedecided by each State) access to family planning medical
services. From what I can tell, this means stuff like STDtesting, contraceptives, etc.
2401Amends theSocialSecurity Act
States may provide those with an income level under 150% of
the poverty line (which, like I said in Part 1, is based on yourage and how many people are in your household) care in anursing home, in-home care, etc. This section is optional forstates 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.
2011
2402
Directs the Secretary of HHS to create regulations for varioustypes of state-provided long-term care (again, stuff like nursing
homes and in-home care), allowing states to cater to those whocould benefit from different kinds of long-term care while stillworking within pre-set standards.
2403
Amends the
DeficitReduction
Act of 2005
This has do with states funding long-term care, andtransitioning into and out of hospitals (as opposed to nursing
homes and in-home care). The Deficit Reduction Act had apart 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).
2404Amends theSocial
Security Act
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 thathappens when your spouse becomes institutionalized in someform 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.
2014-2019
2405
Refers to the
Older
AmericansAct of 1965
Sets aside $50,000,000 (over a five-year period) to help pay
for another bill, the Older Americans Act of 1965.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
12/31
2406
Reiterates how important a topic long-term care is, and says in
a general way that Congress should talk about it more and thatmore support should be made for community-level care (like
nursing homes and in-home care) as opposed to only hospital
care.
2501Amends theSocial
Security Act
Increases the size of the drug rebates poor people get throughMedicaid, and also specifies that no rebates are to be for an
amount higher than the average price of the drug.
NOW
2502
Amends the
Social
Security Act
Allows Medicaid to cover more types of drugs, including
Barbiturates, Benzodiazepines, and drugs that help people to
quit smoking.
2503
Amends the
Social
Security Act
Sets a way to determine what the limits are for how muchMedicaid is supposed to reimburse people for pharmacy drugs.
2551
Amends the
Social
Security Act
This one is cutting a lot of money from payments made tostates called Disproportionate Share Hospital (DSH)
Payments. These are payments that states then turn over to
hospitals to help compensate them for treating emergencypatients 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 getscut based on what percentage of their population is insured, aswell 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.
2601
Amends the
Social
Security Act
Gives States the option to get 5-10-year waivers so they don't
have to follow Federal regulations for Medicaid when it comesto "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 onthese waivers if it looks like a Demonstration Project isn'tworking the way it is intended.
2602
Directs the Secretary of HHR to create the FederalCoordinated 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 peoplewho qualify for both to get the services they're covered for, andmake sure there's not any waste.
2701
Adds section
1139B to theSocial
Security Act
On a yearly basis from 2011-2014, and then every three yearsafter 2014, the Secretary of HHS is to write a report onrecommended 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 bettermethods of adult care (again, like a similar program already inexistence for children). $60 Million will be set aside every
year from 2010-2014 to fund this program.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
13/31
2702
Directs the Secretary of HHS to look at individual state
practices that withhold payment from hospitals for healthconditions caused by the hospitals' own neglect and negligence,
and adopt them as general Medicaid practices.
2703
Amends the
SocialSecurity Act
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 andcoordinate your care.
2011
2704From 2012-2016, the Secretary of HHR will start up a"Demonstration Project" to test the effectiveness of doing
bundled programs in Medicaid.
2012-2016
2705
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 servicethey give, it's based on the quality.
2010-2012
2706
From 2012-2016, The Secretary of HHR will start up another
"Demonstration Project" to give states the opportunity toallow 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 theamount of care patients receive.
2012-2016
2707
The Secretary of HHR will start up another "Demonstration
Project" to give states the opportunity to allow privatepsychiatric hospitals to be covered under Medicaid. Thissection allocates $75 Million for this, and specifies that it will
be a three-year project that will happen sometime between
2011 and 2015.
2011-2015
2801Amends theSocialSecurity Act
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 withCongress 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 - socomparatively speaking not much).
2901Goes into more detail on some rules regarding NativeAmerican Indians and the Indian Health Service.
2902Amends theSocial
Security Act
Extends reimbursement to Native American Indian hospitals
under Medicare Part B, previously due to expire in 2010.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
14/31
2951
Adds section511 to the
SocialSecurity 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 theeffectiveness of substance abuse treatment programs. States
must report this information to the Secretary of HHR, as well asinforming the Secretary of what they intend to do to improvethe situation in their state. This section authorizes the Secretary
to make grants to states for these improvements (with anemphasis on communities in particularly bad shape), and
directs the Secretary to track the improvements made after 3-5years. 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 2010-2014, $1.5 Billion is set aside for this section.
2010-2014
2952Directs the Director of the National Institute of Mental Healthto conduct a study on postpartum depression.
2952
Adds section
512 to theSocial
Security Act
Directs the Secretary of HHS to use grant money forprojects 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.
2010-2012
2953
Adds section
513 to theSocial
Security Act
From 2010-2014, the Secretary of HHR will give each state
funding (based on the size of that state's population betweenages 10-19) for sex education programs (pushing bothabstinence 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 callsfor studies to see how effective these programs are in reducingyouth pregnancy rates.
2954Amends theSocialSecurity Act
Reinstates funding for abstinence-only sex educationprograms from 2010-2014 to states.
2010-2014
2955
Amends the
SocialSecurity Act
Children without a parent (or who don't want their parents to bein charge of their medical decisions) are given more
information about the importance of designating a Power ofAttorney when it looks like they may need one to make medical
decisions for them.
2010
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
15/31
APPENDIX C: Title III (Improving the Quality & Efficiency of Health Care)
PPACA Codification Description Effective
Date
3001 Amends theSocial
Security Act
The Secretary of HHS will establish a "hospital value-basedpurchasing program" so that instead of reimbursing hospitals
based on the number of patients they have treated, they arereimbursed based on their success with a measure of specific
conditions (heart failure, pneumonia, acute myocardial
infarction), surgeries, and stuff like negligence. These measuresare to take into account stuff like age, sex, race, severity ofillness, etc., as well as the hospitals' prior success with these
conditions, how much they've improved, and how theycompare to other hospitals.
2013
3002 Amends the
Social
Security Act
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 qualitymeasures taken in their hospital. This amount decreases in
2012, and ends in 2015. Starting in 2015, doctors who fail tomake these reports will have their pay reduced, and in 2016 itwill be reduced even further.
3003 Amends the
SocialSecurity Act
Direct the Secretary of HHS to starting using claims data (and
possibly other data) to give doctors information about resourcesand methods available to them to improve care for their
patients.
2012
3004 Amends the
SocialSecurity Act
Long-term care hospitals that fail to report to the Secretary of
HHS about the quality measures taken in their hospital willreceive reduced funding.
2014
3005 Amends theSocial
Security Act
Directs "PPS-Exempt Cancer Hospitals" to report to theSecretary of HHS about the quality measures taken in their
hospital.
2014
3006 Directs the Secretary of HHS to develop a "value-basedpurchasing plan" in Medicare for "skilled nursing facilities",
"home health agencies" and "ambulatory surgical centers", tomake the pay they get under Medicare to be based on the
quality of care they give based on criteria to be determined bythe Secretary.
3007 Amends the
SocialSecurity Act
Directs the Secretary of HHS to come up with a "value-based
payment modifier" to begin in 2013, which will pay doctorsbased on the quality and cost-effectiveness of their care (based
on measures to be set by the Secretary).
2013
3008 Amends theSocial
Security Act
Hospitals get less money when they treat patients for problemscaused 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.
2015
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
16/31
3011 Adds section
399HH to thePublic HealthService Act
Directs the Secretary of HHR to create a report in 2011 on a
strategy to improve the delivery of health care services that willbe presented to Congress. This strategy will be updated at leastonce a year, with annual updates submitted to Congress.
2011
3012 Directs the President to put together an "Interagency WorkingGroup 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 lastsection. This group is to present a yearly report to Congress ontheir progress and recommendations.
3013 Adds section
931 to thePublic HealthService Act /
Amends the
SocialSecurity Act
Directs the Secretary of HHR to consult with the Director of
the Agency for Healthcare Research and Quality and theAdministrator of the Centers for Medicare & Medicaid Servicesat 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 theAdministrator of the Center for Medicare & Medicaid Servicesdevelop quality measures for those programs. From 2010-2014,$375 Million will be set aside for this section.
3014 Amends the
SocialSecurity Act
The part of the Social Security Act it refers to creates a
privately-owned non-profit group comprised of both healthinsurance representatives, as well as representatives ofconsumer advocacy groups, whose job it is to recommend ways
to improve the quality and efficiency of health-care. What thissection 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.
3015 Adds section399II to thePublic HealthService Act
The language is a bit confusing, but it looks like this sectiondirects the Secretary of HHR to create more efficient ways tocollect data on the cost and effectiveness of health care, anddirects the Secretary to give grants and contracts to
organizations and individuals that will assist in this task.
3021 Adds section
399JJ to the
Public HealthService Act
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 howeffective different health care providers are.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
17/31
3022 Adds section
1899 to theSocialSecurity Act
Secretary of HHS is to establish the Medicare Shared Savings
Program. This program allows for the creation ofAccountableCare Organizations (ACOs), organizations comprised of agroup 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, andhow they are to be measured and reported. Basically, if ahospital or other qualified group of caregivers can find ways toreduce 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).
2012
3023 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 lowercosts 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.
3024 Adds section
1866E to the
SocialSecurity Act
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 thatmaybe if people with chronic conditions can get check-ups at
home, they'll be less likely to need to go back to the hospitalrepeatedly 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 fortheir patients while still meeting these standards will get
incentive payments. $30,000,000 is set aside for this programfrom 2010-2015, and the Secretary is to report to Congress on
its progress.
2012
3025 Amends the
SocialSecurity Act
Payments made under Medicare to hospitals will be slightly
reduced in cases of excessive readmission. This is apparently toencourage 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 sameproblem. P/x: High readmissions are purportedly a big drain onMedicare. "One in five patients discharged from a hospital -
approximately 2.6 million seniors - is readmitted within 30days, at a cost of over $26 billion every year"
2012
3025 Adds section399KK to the
Public HealthService Act
Within two years of the enactment of this section, the Secretaryof HHS will make a program for hospitals with a high amount
of readmissions to improve their readmission rates. So, whilethe 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 theSecretary on the changes they make and how effective they are.
2012
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
18/31
3026 The Secretary of HHR will create a program to try and improve
the care for patients being transitioned from one location (like ahospital) to another (such as the at-home care orCommunity-Based Organizations.
2011-2016
3027 Amends the
DeficitReductionAct of 2005
Extends a demonstration project in that bill to last roughly
another year, and setting aside an additional $1,600,000 forthis.
3102 Amends theSocial
Security Act
Renews part that sets a bottom limit for the Work GeographicIndex (used for determining Medicare costs), as well as adding
what looks like some additional criteria for determining those
costs.
3103 Amends the
SocialSecurity Act
Renews part that allows people to be exempted from some of
the costs due to physical therapy expenses.
3104 Amends
Medicare,
Medicaid,and SCHIPBenefits
Improvements and
Protection
Act of 2000
This provision is ridiculously hard to understand, but it seems
to simply extend Medicare payments for laboratory services for
an additional year (until 2010).
-2010
3105 Amends theSocial
Security Act
Also difficult to understand, but it's seems to simply renewfunding for ambulance services for Medicare patients through
2011.
2010-2011
3106 AmendsMedicare,
Medicaid,and SCHIPExtensionAct of 2007
Hard to understand; renews funding for long-term carehospitals for Medicare patients for another two years.
2010-2012
3107 AmendsMedicareImprovement
s for Patients
and ProvidersAct of 2008
Extends funding for mental health treatments for Medicarepatients an additional year (until 2010).
-2010
3108 Amends theSocialSecurity Act
Physician Assistants are added to the list of professionals (linenurses and doctors) allowed to order "post-hospital extendedcare 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
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
19/31
3109 Amends the
SocialSecurity Act
Clarifies when pharmacies have to send accreditation
information regarding their quality standards to the Secretary ofHHS, as well as indicating exemptions for certain types ofpharmacies.
3110 Amends the
SocialSecurity Act
Some beneficiaries ofTricare (civilian health benefits for
veterans) will have an additional year to enroll in Medicare PartB, if they choose to do so.
-2010
3111 Amends theSocialSecurity Act
Reduces the amount paid to hospitals for X-Ray bone densityscans in 2010 and 2011, as well as directing the Secretary ofHHR to work with the Institute of Medicine of the National
Academies to conduct a report on the effect that this has.
2010-2011
3112 Amends the
Social
Security Act
Cuts all the funds going to the Medicare Improvement Fund
in 2014. This cuts $22,290,000,000.
2014
3113 Amends the
SocialSecurity Act
Directs the Secretary of HHS to conduct a two-year
demonstration project, starting July 1, 2011, where complex labtests 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 thisaffected expenses and quality of care. $5,000,000 is set asidefor this section from the Centers for Medicare & Medicaid
Services Program Management Account, and the actual
payments themselves are to get funds from the FederalSupplemental Medical Insurance Trust Fund.
3114 Amends theSocialSecurity Act
Nurse-midwife services received through a fee schedule canreceive up to as much as if those same services wereadministered by a doctor. The apparent purpose is to make
nurse-midwife services more accessible.
2011
3121 Amends theSocialSecurity Act
Renews Medicare coverage for outpatient services in ruralhospitals for another year (through January 1, 2011).
2010
3122 AmendsMedicarePrescription
Drug,
Improvement, andModernizatio
n Act of 2003
Extends from July 1, 2010 to July 1, 2011, payments to ruralhospitals for clinical diagnostic laboratory tests covered underMedicare Part B.
2010-2011
3123 Amends
MedicarePrescriptionDrug,
Improvement
, andModernization Act of 2003
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 to30, 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 thelanguage fit better.
2010
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
20/31
3124 Amends the
SocialSecurity Act
Extend the Medicare Dependent Hospital (MDH) program
for rural hospitals for another year (through October 1, 2012).
2010-2012
3125 Amends theSocial
Security Act
For the fiscal years 2011 and 2012, the amount paid to low-volume 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 toinclude hospitals that are over 15 miles away from another
qualifying hospital (instead of 25 miles away).
3126 Amends the
MedicareImprovements for Patients
and Providers
Act of 2008
Expands a demonstration project revolving around
community-level integrated health services on a county-by-county level. This section also removes the restriction on thenumber of counties that can be included in this demonstration
project, and replaces some terminology.
3127 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.
2011
3128 Amends the
SocialSecurity Act
Increases payments for emergency hospital services and
ambulances from 100% of what is deemed a "reasonable cost"to 101%.
3129 Amends the
SocialSecurity Act
Gives grant money to rural hospitals, which stays available
until it is used rather than expiring.AMT? It also adds that thisgrant money can now be used to make sure these hospitals areup to the standards set in the PPACA.
2010
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
21/31
3131 Amends the
SocialSecurity Actand the
Medicare
Prescription
Drug,Improvement, andModernizatio
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 anumber 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 theMedicare Payment Advisory Commission to conduct a studyon the effect this has on access to and quality of care. Thisreport 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 thesecaregivers in a number of different ways. This section alsoalters another bill, the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, to increase
the payments made to rural home health services by 3% fromApril 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 thanMarch 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 lastfor 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 Fundto fund both the study and thedemonstration project. And if the Secretary does choose to go
ahead with this demonstration, he is to evaluate and report on itto Congress.
2014
3132 Amends the
SocialSecurity Act
Directs the Secretary of HHS to gather data on payments for
hospice care starting no later than January 1, 2011. At somepoint after October 1, 2013, the Secretary is to revise paymentsfor 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.
2011
3133 Amends the
Social
Security Act
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 inthe provision It's a bit complicated, but apparently it cuts thesepayments by about 75%. P/x: cut is on the basis that hospitals
will have fewer uninsured patients to treat by 2014.
2014
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
22/31
3134 Amends the
SocialSecurity Act
Directs the Secretary ofHHS to identify which services are
"misvalued" (that are more expensive than they need to be orcan be made more efficient through bundling). The Secretary isto 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 costsfor these services. It also repeals a part of the Social SecurityAct that I'm having difficulty finding, but apparently saidsomething similar.
3135 Amends the
SocialSecurity Act
Starting in 2011, it's increasing from 50% to 75% a rate used in
determining expenses related to costly diagnostic imagingequipment. and reduces the payments for the use of thisequipment by 25%. This section also directs the Chief Actuary
of the Centers for Medicare & Medicaid Services to report onwhether 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.
2011
3136 Amends the
SocialSecurity Act
Changes the Medicare payment for powered wheelchairs.
Beginning on January 1, 2011, for the first three months ofpaying for a powered wheelchair, it goes up from 10% of thecost to 15% of the cost, and for subsequent months it goes
down from 7.5% of the cost to 6% of the cost.
3137 Amends theTax Relief
and HealthCare Act of
2006
This provision was incredibly difficult to understand. Thesection alters another bill, the Tax Relief and Health Care Act
of 2006, directing the Secretary of HHR to report to Congressno later than December 31, 2011 on reforming the hospital
wage index, which determines how Medicare will compensatevarious medical professionals. Anyway, the Secretary's report
is to take numerous factors into consideration. P/x: Thisprovision is intended to contain costs. SeeLaw, Explanationand Analysis of the Patient Protection and Affordable Care
Act: Including Reconciliation Act Impact495 (vol. 1, 2010).
2011
3138 Amends the
SocialSecurity Act
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.
3139 Amends the
SocialSecurity Act
Refers to payments forbiosimilar biologics. Biologics are
medical treatments made from living organisms (like vaccines),and "biosimilar" refers to products that are effectively the sameas 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 chanceto break into the market so they can compete with major drugcompanies that already exist.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
23/31
3140 Directs the Secretary of HHS to establish a Medicare Hospice
Concurrent Care demonstration program, which will lastfor 3 years. Hospice care is care for patients who are dying thatdoesn'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 tochoose both. This demonstration program is intended to becost-neutral, and the Secretary is to report to Congress on howthis affected quality of care and cost-effectiveness.
3141 Directs the Secretary of HHS in how to go about calculating the
Hospital Wage Index Floor apparently, to ensure that nohospital has a wage index beneath what is legally required,
while still making the changes in wage indexes budget neutral.
3142 Directs the Secretary of HHS to conduct a study on costs and
payments in urban Medicare-dependent hospitals. Within 9months of the enactment of the PPACA, the secretary will
submit this report to Congress.
2011
3143 Says that nothing in the PPACA will reduce home health
benefits guaranteed in the Social Security Act.
3201 Amends theSocial
Security Act
Involves lots of numbers; seems to lower the amount paid forMedicare Advantage until the costs are more in line with the
costs of normal Medicare.
3202 Amends theSocialSecurity Act
Some specific services underMedicare Advantage cannot costmore than those under Medicare Part A and B. This isessentially just additional details on the cost-saving stuff in
section 3201. Also a lot of numbers talk regarding Medicare
Advantage rebates.
2011
3203 Amends theSocialSecurity Act
Adjustment of costs forMedicare Advantage servicescontinues on a yearly basis (prior to HCERA, it only continueduntil 2010).
3204 Amends theSocialSecurity Act
For the first 45 days of the year, people enrolled in MedicareAdvantage can choose to change their plan to a standardMedicare plan.
2011
3205 Amends the
Social
Security Act
Extends the Medicare Advantage Special Needs Program
through 2014, as well as listing a lot of requirements that these
plans would need to meet.
2010-2014
3206 Amends the
SocialSecurity Act
Renews until January 1, 2013 the ability for Medicare
recipients to obtain Reasonable Cost Contracts.
2010-2013
3207 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.
3208 Amends the
Social
Security Act
Makes permanent senior housing facilities created under a
specific demonstration project as of December 31, 2009.
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
24/31
3209 Amends the
SocialSecurity Act
Clarifies that the Secretary of HHS has the right to reject bids
for plans by a Medicare Advantage organization, and bids forplans by a Prescription Drug Plan sponsor, if those planspropose significant increases to costs or reductions to service.
3210 Amends the
SocialSecurity Act
Directs the Secretary of HHS to request the National
Association of Insurance Commissioners to revise standardsfor supplemental Medicare benefit plans.
3301 Amends theSocial
Security Act
Any drug companies wanting to continue to work withMedicare Part D must participate in the Medicare Coverage
Gap Discount Program outlined in this section. It outlines theactual Medicare Coverage Gap Discount Program, which
was set to start at the same time (January 1, 2011). This sectionaddresses the infamous "Donut Hole" in coverage, which
plagued Medicare recipients who purchased enough drugs tosurpass the prescription drug coverage limit, but not enough toqualify for catastrophic coverage. It does so by making the drug
companies that work with Medicare give discounts to those
who fall within that gap.
2011
3302 Amends the
SocialSecurity Act
The low-income benefit for Medicare part is calculated without
taking into consideration discounts and rebates received underMedicare Advantage. This way, those getting discounts likethat won't be penalized for it when purchasing drugs.
3303 Amends theSocial
Security Act
Secretary of HHS can allow a prescription drug plan to chargelow-income beneficiaries the low-income subsidy if the plan's
premium is more expensive than the low-income subsidy plus a"de minimis" amount.
2011
3304 Amends the
SocialSecurity Act
This section deals with widows and widowers on low-income
assistance. Normally, Centers for Medicare and MedicaidServices 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, theymay no longer qualify as "low income". However, when
someone's wife or husband dies, they surviving spousegenerally inherits their significant others' stuff. This section
says that that check on beneficiaries' status can not happenwithin a year of the death of a spouse, so someone isn't dropped
from Medicare or Medicaid just because they lost a loved one.
2011
3305 Amends theSocial
Security Act
When the Secretary of HHR reassigns someone to a differentMedicare drug plan (apparently due to a change in their
economic status), they are to be informed of the differencesbetween their old plan and the new one, as well as beinginformed of their right to request a coverage determination,
exception, or reconsideration.
2011
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
25/31
3306 Amends the
MedicareImprovements 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, anadditional $15,000,000 be set aside to fundAging andDisability 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 supportfrom the entities funded by this section for wellness and diseaseprevention outreach programs.
2010-2012
3307 Amends the
Social
Security Act
Medicate Advantage insurance companies must include
coverage for specific categories of drugs designated by the
Secretary of HHS. Until the secretary designates which drugsare to be covered, these categories are to includeanticonvulsants, antidepressants, antineoplastics,
antipsychotics, antiretrovirals, and immunosuppressants for the
treatment of transplant rejection.
2011
3308 Amends the
SocialSecurity Act
If you make over $80,000 ($160,000 for couples filing taxes
jointly), yourMedicare Part Dmonthly costs will increase ina fashion similar to Medicare Part B. This amount will be
taken out of your social security.
2011
3309 Amends the
Social
Security Act
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 underMedicare Part D.
2012 (?)
3310 Amends the
SocialSecurity Act
Drug plans for patients in long-term care facilities must be
more efficiently managed and drugs given to patients must bedispensed in a more efficient manner, using uniform dispensingtechniques, to reduce waste.
3311 Directs the Secretary of HHS to create and maintain acomplaint system, to be made available on Medicare.gov, andthe Secretary shall report yearly to Congress on this system.
(http://medicare.gov/claims-and-appeals/file-a-
complaint/complaints.html)
2010
3312 Amends theSocial
Security Act
Makes a standard and uniform appeals process for those whofeel their claim should not have been denied.
2012
3313 Directs the Inspector General of the Dept. of HHS to conduct a
study about the type of drugs used by those in MedicareAdvantageplans, 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 mostfrequently-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.
2011
3314 Amends the
SocialSecurity Act
Drugs paid by AIDS drug programs and Indian Health
Services count towards calculations for determiningqualification forMedicare Part D catastrophic care.
2011
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
26/31
3315 Amends the
SocialSecurity Act
Gives a $250 rebate to Medicare recipients who fall into that
"donut hole" that mentioned in Section 3301. It's only in effectfor one year.
2010
3401 Amends theSocial
Security Act
Reduces the increases in payments that many various types ofmedical facilities and services were going to be getting through
Medicare.
3402 Amends the
Social
Security Act
From Jan. 1, 2011 through Dec. 31, 2019, income thresholds
forMedicare Part B will be frozen at their 2010 levels, rather
than being tied to inflation like they previously had been.
3403 Amends theSocial
Security Act
Creates the Independent Medicare Advisory Board. Theboard is to be comprised of 15 experts (who cannot hold any
other employment while they are part of the board, so there's noconflict 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 benonvoting members. The presidential appointees serve 6-yearnonconsecutive terms. The board's purpose is to reduce
Medicare spending per person by submitting proposals to beenacted by the Secretary unless Congress says otherwise. These
proposals must cut costs, must not ration health care, and mustnot increase costs to Medicare recipients, must not cut
Medicare benefits, and must not modify eligibility criteria.
3501 Adds section
933 to the
Public HealthService Act
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 though2014 to be put towards carrying out this section.
3501 Adds section
934 to the
Public HealthService Act
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 measuresmentioned in Section 933. Recipients of these grants need to
match every $5 of funds they receive with $1 of their own.
3502 Directs the Secretary of HHS to establish a program to providegrants for community-based "health teams" to support primary
care providers. These "health teams" need to have a plan to beself-sustaining within three years. P/x: Creates a community-
based support system of professionals so primary care doctorshave specialists to refer patients to.
3503 Adds section
935 to thePublic HealthService Act
Directs the Secretary of HHS to establish a program to provide
grants to implement medication management services for thetreatment of chronic diseases.
2010
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
27/31
3504 Adds section
1204 to thePublic HealthService Act
Directs the Secretary of HHR to award at least 4 multi-year
contracts to states that support pilot projects to test innovativenew ways to do regional emergency care. States have to matchevery $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.
3504 Adds section498D to the
Public Health
Service Act
Directs the Secretary of HHR to support research of variousgovernment agencies in emergency medical care systems and
emergency medicine.
3505 Amends the
Public Health
Services Act
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 detailas to what sort of trauma centers can get the grants and what
sort of grants they can get.
3505 Adds section
1245 to thePublic Health
Service Act
Sets aside $100,000,000 to pay for the previous section in
2009, and "such sums as may be necessary" from 2010
through 2015.
2009-2015
3505 Adds section1246 to the
Public Health
Service Act
Clarifies what "uncompensated care costs" means.
3505 Adds section
1281 to thePublic Health
Service Act
Allows states to award grants to create or strengthen trauma
centers.
3505 Adds section1282 to thePublic Health
Service Act
Sets aside $600,000,000 to pay for the previous section in
2010 though 2015.2010-2015
3506 Adds section936 to the
Public Health
Service Act
Directs the Secretary of HHS to create a program to providegrants 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 oftreatment. These materials are to be made freely available.
3507 Directs the Secretary of HHS to conduct a study to determine
whether health care decision-making would be improved bystandardizing the way drug information is presented on
prescription drugs. This study is to be done by 2011, and if it isdetermined that it would be improved, within 3 years theSecretary is to create regulation to enact that standardization.
2011
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
28/31
3508 Directs the Secretary of HHS to award grants for
demonstration projects to medical schools that incorporatequality 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, theSecretary is to start submitting a yearly report to Congress onwhat demonstration projects are underway and how well they'redoing.
2012
3509 Adds section229 to the
Public HealthService Act
Establishes an Office on Women's Health under the Secretaryof HHS, to be headed by a Deputy Assistant Secretary for
Womens Health. This office is intended to advise the Secretaryon issues relating to women's health, as well as to establish the
National Womens Health Information Center, which is toassist with providing information regarding issues that effectwomen'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 takeover the functions previously belonging to the Office onWomens Health of the Public Health Service.
2011
3509 Adds section
310A to thePublic HealthService Act
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.
3509 Adds section925 to the
Public Health
Service Act
Establishes an Office on Women's Health and Gender-BasedResearch 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.
3509 Adds section713 to the
SocialSecurity Act
Directs the Secretary of HHS to establish an Office onWomen's Health under the Office of the Administrator of
the Health Resources and Services Administration. Thisoffice is intended to advise the Administrator on issues relating
to women's health, and to take over any Health Resources andServices Administration programs relating to womens health.
3509 Adds section
1011 to theFederal Food,
Drug, &
Cosmetic Act
Establishes an Office on Women's Health under the
Commissioner of Food and Drugs, headed by a directorappointed 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.3510 Amends the
Public HealthServices Act
Extends from 2010 through 2014 the "Patient NavigatorProgram." This is essentially extending a program to helppatients find the services they need.
(http://www.altfutures.com/draproject/pdfs/Report_07_02_Patient_Navigator_Program_Overview.pdf)
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
29/31
3511 Authorizes the Secretary of HHS to appropriate funds for this
part of the bill.
3601 Says nothing in this bill will reduce guaranteed Medicarebenefits, 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.3602 Says "nothing in this Act shall result in the reduction or
elimination of any benefits guaranteed by law to participants inMedicare Advantage plans."
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
30/31
APPENDIX D: Title IX (Revenue Provisions)
PPACA Codification Description Effective
Date
9001 Adds section
4980I to IRC
40% excise tax on employer sponsored health coverage above a
threshold.
2018
9002 Addsparagraph tosection
6051(a) of
IRC
Must include aggregate cost of employer-sponsored healthcoverage on annual Form W-2 for employees
2011
9003 Amendssections 106,
220, and 223
of IRC
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.
2011
9004 Amends
sections 220
and 223 ofIRC
Increase in additional tax on distributions from HSAs not used
for qualified medical expenses to 20%
2011
9005 +
10902(RECON)
Amends
section 125of IRC
Limits FSA contributions to $2,500 (indexed in future years). 2013
9006 Amendssection 6041
of IRC
Expands information reporting requirements on 1099. Repealed
9007 Amendssections 501
and 6033 ofIRC
Additional reporting requirements for charitable hospitals 2010
9008 Refers tosection
275(a)(6) ofIRC
Flat annual fee imposed on branded prescription drug sales tospecified government programs
2010
9009 +
10904
(RECON)
Refers to
section
275(a)(6) ofIRC
Flat annual fee imposed on medical device manufacturers. 2010
9010 Refers to
section275(a)(6) ofIRC
Flat annual fee on non-government health insurers based on
market share. $8 billion in 2014, $11.3 billion in 2015 and2016; $13.9 billion 2017; $14.3 billion in 2018; increased byrate of premium growth thereafter. Amended to exempt any
non-profit entity incorporated under State law or any entitydescribed in section 501(c)(4) that provides commercial-typeinsurance, if their premiums are regulated by a State authority...
(i.e. Exemption for Exchanges?)
2014
9012 Amendssection 139A
of IRC
Eliminates deduction for expenses allocable to Medicare Part Dsubsidy.
2013
-
7/27/2019 Breakdown of Patient Protection & Affordable Care Act (Titles I, II, III, XIII)
31/31
9013 Amends
sections 213and 56 ofIRC
Raises floor on medical expense deduction to 10% of AGI.
(after 2017 for seniors).
2013
9014 Amendssection
162(m) ofIRC
Limitation on excessive remuneration paid by certain healthinsurance 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.
2010
9015 +
10906
(RECON)
Amends
section 164,
3101, and3202 of IRC
Additional 0.9% Hospital Insurance Tax under FICA on high-
income taxpayers making over $200,000 a year (or $250 if
filing jointly).
2013
9016 Amendssection
833(c) ofIRC
Health organizations with medical loss ratios below 85% don'tqualify for same tax treatment as BCBS organizations.
2010
9017 +10107(RECON)
Amendssection5000B of
IRC
Imposes a 10% tax on the amount paid for indoor tanningservices on individual in which the services are performed.
2010
9021 Amends
section 139Dof IRC
Health benefits provided by Indian tribal governments are
excluded from gross income.
2010
9022 Amends
section 125
of IRC
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-employedindividuals may be counted as qualified employees.
2011
9023 Amends
sections 46,
48D, 49(a),& 280C(g)
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.
2009
SUBSEQUENT AMENDMENTS
1402 Amendssections 1411and 6654 of
IRC
Imposes a new 3.8 percent tax on the lesser of net investmentincome or the excess of modified AGI over $200,000 (or$250,000 if filing jointly).
2013
1409 Adds toscattered
sections of
IRC
Codification of the economic substance doctrine (defined undersection 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 is20%, increased to 40% if the taxpayer does not adequately
disclose the relevant facts affecting the tax treatment in thereturn or a statement attached to the return.
Applies tot/a entered
into after
Mar. 30,2010
1410 Increases quarterly estimated tax due in July, August, orSeptember 2014 by 15.75 percentage points.
2010