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EFFECTIVE: |
AHCA/NCAL LEAD: |
PPACA SECTION: |
PROVISION SUMMARY: |
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1/1/10
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Elise Smith |
§6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More than 12 Months
Reed Smith Health Care Reform Review - page 105
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· Reduces the maximum period for submission of Medicare claims to not more than 12 months from the date of service |
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3/1/10
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Steven Gregory |
§2602 - Providing Federal Coverage and Payment Coordination for Dual Eligible Beneficiaries
Reed Smith Health Care Reform Review - page 18
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· Establishes a Coordinated Health Care Office reporting to the CMS Administrator, with the purpose of ensuring that Medicare/Medicaid dual eligibles obtain full access to items/services
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3/23/10 (Information must be available for submission to the Federal government upon request)
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Lyn Bentley |
§6101 - Required Disclosure of Ownership and Additional Disclosable Parties Information
Reed Smith Health Care Reform Review - pages 96-97 |
· Expands the information a nursing facility must disclose to include the organizational structure, as well as additional information on officers, directors, trustees and managing employees of the facility, including names, titles and dates of service
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3/23/10 |
Steven Gregory |
§6402 (a) - Medicare and Medicaid Overpayments
Reed Smith Health Care Reform Review - pages 102-104
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· Requires all overpayments be reported and returned within 60 days from the date of identification or by the date that the corresponding cost report is due (as applicable)
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3/23/10
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Steven Gregory |
§6506 - Overpayments
Reed Smith Health Care Reform Review - page 109
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· Extends the period for states to repay overpayments to 1 year when a final determination of the amount of the overpayment has not been determined because of an on-going judicial or administrative process
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3/23/10 |
Priscilla Shoemaker |
§§6701-03 - Elder Justice Act
Reed Smith Health Care Reform Review - page 111-112 |
· Mandates reporting of “reasonable suspicion” of any crime against a resident to HHS Secretary and local law enforcement up to $300K with possible exclusion from the Medicare/Medicaid programs for failure to report
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4/1/10 |
Steven Gregory |
§10201; as amended by §1201 of The Reconciliation Act - Amendments to the Social Security Act and Title II of this Act
Reed Smith Health Care Reform Review – pages 8-9
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· Starts the Medicaid state option to cover adults at or below 133% of the Federal Poverty Level (FPL), and includes a number of clarifications and policy adjustments related to the Medicaid expansion to 133% of FPL
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4/1/10 |
Janice Zalen |
§2402 – Removal of Barriers to Providing HCBS
Reed Smith Health Care Reform Review – page 13
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· Provides states more flexibility to provide Home- and Community-Based Services (HCBS) and to extend full Medicaid benefits to individuals receiving these services. |
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6/21/10
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Karl Polzer |
§1101 - Immediate Access to Insurance for Uninsured Individuals with Pre-Existing Conditions
Reed Smith Health Care Reform Review – page 3 |
· Provides uninsured adults with pre-existing conditions access to coverage. A temporary high-risk pool will serve as a bridge until the new health insurance Exchanges (starting in 2014) are up and running; at which time insurance companies will no longer be able to deny coverage on pre-existing conditions
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6/21/10
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Karl Polzer |
§1102 - Re-Insurance for Early Retirees
Reed Smith Health Care Reform Review – page 3
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· Creates a temporary reinsurance program (until 2014 when the health insurance Exchanges are available) to help offset the costs of expensive premiums for employers and retirees (age 55-64) for health benefits for retirees
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9/23/10
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Karl Polzer |
§1001 – Amendments to the Public Health Service Act
Reed Smith Health Care Reform Review – page 3 |
· Prohibits insurers from imposing lifetime limits on beneficiaries (applies to all plans)
· Requires health plans that provide coverage for children to continue that coverage until the child turns 26
· Prevents insurance companies from withdrawing coverage when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs
· Regulates plans’ use of annual limits to ensure access to needed care in all group plans and all new individual plans (applies to new plans in the individual market and all employer plans)
· Requires coverage of preventative services at no charge by exempting these benefits from deductibles and other cost-sharing requirements (applies to all new plans)
· Requires an effective internal and external appeals process for coverage determinations and claims (applies to all new plans)
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9/23/10
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Karl Polzer |
§1201; as amended by §10103(e) of The Reconciliation Act – Health Insurance Market Reforms |
· Prohibits health plans from denying access to and coverage of children with pre-existing conditions up to age 19 (applies to all new health plans and grandfathered group health plans)
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9/30/10
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Dianne
De La Mare |
§5101 - National Health Care Workforce Commission
Reed Smith Health Care Reform Review – page 82
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· Establishes an independent National Workforce Commission to provide comprehensive, objective information and recommendations to Congress and the Administration for aligning federal health care workforce resources with national needs
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10/1/10
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Bill Hartung |
§10325 - Revision to SNF Prospective Payment System
Reed Smith Health Care Reform Review – page 53
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· Foregoes any delay on the implementation of the changes to the concurrent therapy rules or the look-back period, or launch of the MDS 3.0
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12/31/10
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Chris Condeelis |
§3012 – Interagency Working Group on Health Care Quality
Reed Smith Health Care Reform Review – page |
· Creates the Interagency Working Group on Health Care Quality to ensure collaboration between Federal agencies; avoid inefficient duplication of quality improvement; and assess alignment of quality efforts in the public sector
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12/31/2010
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Elise Smith |
§6411 - Expansion of the Recovery Audit Contractor (RAC) Program
Reed Smith Health Care Reform Review – page 107 |
· Expands the RAC program to Medicaid and Medicare Parts C and D
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2010 |
Bill Hartung |
§1421 - Credit for Employee Health Insurance Expenses of Small Businesses
Reed Smith Health Care Reform Review – page 4
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· Provides a tax credit for qualified small businesses to help them afford insurance coverage of their workers
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2010
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Elise Smith |
§3103 - Extension of Exceptions Process for Medicare Therapy Caps
Reed Smith Health Care Reform Review – page 43
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· Extends the outpatient therapy cap exception process through 2010 |
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2010
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Elise Smith |
§3301 - Medicare Coverage Gap Discount Program
Reed Smith Health Care Reform Review – pages 57-59
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· Provides $250 rebate check for Part D enrollees who hit the gap in prescription drug coverage known as the “donut hole”
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2010
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Dianne
De La Mare |
§§5201-5207, 10501 - Loan Repayment/Grant Availability
Reed Smith Health Care Reform Review – page 83
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· Expands and improves low-interest student loan programs, scholarships and loan repayments for health students and professionals
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2010-2014 |
Chris Condeelis |
§2701 - Adult Health Quality Measures
Reed Smith Health Care Reform Review – page 19
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· Mandates HHS Secretary to publish a recommended core set of adult health quality measures for Medicaid-eligible adults
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2010-2020+
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Janice Zalen |
§§3021, 10306 - Establishment for Center for Medicare and Medicaid Innovation within CMS
Reed Smith Health Care Reform Review – pages 35-37
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· Expands HHS Secretary authority to resolve health care financing issues and to develop innovative methods for the administration of Medicare/Medicaid
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