Health Care Reform Update (Part 2)

 Last week we looked at the Health Care reform changes that have taken place or will happen this year. This week, we look at years 2013 and beyond. Starting in 2013, we will begin enrollment procedures in many states for the insurance exchanges required to be in place by 2014. States will have some leeway in getting their exchange up and running but the Federal Government has stated that they will implement an exchange for any states that have not begun the process on their time line.
 Improving Quality and Lowering Costs
· Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013.
· Expanded Authority to Bundle Payments.The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test is billed separately to Medicare.  For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.  It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective January 1, 2013.
Increasing Access to Affordable Care
· Increasing Medicaid Payments for Primary Care Doctors.  As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013.
· Additional Funding for the Children’s Health Insurance Program.  Under the new law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid.  Effective October 1, 2013.Click here to learn more.
 New Consumer Protections
· No Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also limits the ability of insurance companies to charge higher rates due to gender, health status, or other factors. Effective January 1, 2014.
· Eliminating Annual Limits on Insurance Coverage. The law prohibits plans from imposing annual dollar limits on the amount of coverage an individual may receive.  Effective January 1, 2014.
· Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial.  Applies to all clinical trials that treat cancer or other life-threatening diseases.  Effective January 1, 2014.
Improving Quality and Lowering Costs
· Makes Care More Affordable.  The act includes tax credits to make it easier for the middle class to afford insurance will become available for people with incomes above 100 percent and below 400 percent of poverty ($43,000 for an individual or $88,000 for a family of four in 2010) who are not eligible for or offered other affordable coverage. These individuals may also qualify for reduced cost-sharing (e.g. copayments, coinsurance, and deductibles).  Effective January 1, 2014.
· Establishing Health Insurance Exchanges. The law calls for health insurance exchanges to open in each State to enable all Americans to easily shop for more affordable private insurance.   Plans offered in the exchange provide at least a basic level of benefits and services. The Exchanges will increase competition and consumer choice, make our health insurance marketplace more transparent and help bring down costs. Effective January 1, 2014.
· Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50 percent of the employer’s contribution to provide health insurance for employees.  There is also up to a 35 percent credit for small nonprofit organizations.  Effective January 1, 2014. Click here to learn more.
Increasing Access to Affordable Care
· Increasing Access to Medicaid. Americans who earn less than 133 percent of poverty (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing to 90 percent federal funding in subsequent years. Effective January 1, 2014.
· Promoting Individual Responsibility. Under the new law. most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, they will be eligible for an exemption. Effective January 1, 2014.
· Ensuring Free Choice. Workers who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new health insurance exchanges.  Effective January 1, 2014.
Improving Quality and Lowering Costs
· Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified to reflect the quality of care they provide so that providers who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.
For more information on what employee benefit options may be available to your company and its employees, please contact your LL Roberts Group PEO Consultant (toll free) at 877.878.6463.
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