Fluent Essays

Instructions This assignment/project will cover the length of the entire course with a portion of the project due each module. You will select a role and address the assignment each week from that perspective.  The project will require you to assess the impact of a specific provision included in the Affordable Care Act (ACA) on your specific role and discipline in the healthcare arena. Examine how this provision will change processes or specific duties associated with your role. Think about your organization and the services it provides and the population it serves, when thinking through the selected ACA provision.  Select from the positions and organizations listed below:  Public Health Manager for Hillsborough County, FL North General Hospital’s Medicaid Liaison for the State of New York Patient Advocate for the City of Los Angeles, CA Marketing Supervisor for the Mayo Clinic in Phoenix, AZ Healthcare Administrator for Sunnyside Assisted Living Facility in Dallas, TX Director of the Business Office for Kansas City HealthNetwork in Kansas City, MI Assessment Requirements/Submission Requirement: Select a provision from the link upload below to complete the assignment Write a 2-3 page paper that provides key details of the specific provision in the ACA. Be sure to include the following:  Share the name/title of the provision. Explain the purpose of the provision. Describe the issue or concern that the provision is hoping to address. Explain whether there were different points of view for or against the inclusion of the provision and why. Discuss how the specific ACA provision impacts you or your organization, based on the role you have selected. Share your thoughts on whether the implementation of the provision positively or negatively affects you or your organization and its values. Explain how. Use at least 3 credible sources from the Rasmussen library https://guides.rasmussen.edu/az.php Include in-text citations throughout your paper. Format paper, citations and reference page following APA guidelines. LEGISLATIVE COUNSEL ! 111TH CONGRESS 2d Session PRINT 111–1 COMPILATION OF PATIENT PROTECTION AND AFFORDABLE CARE ACT [As Amended Through May 1, 2010] INCLUDING PATIENT PROTECTION AND AFFORDABLE CARE ACT HEALTH-RELATED PORTIONS OF THE HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 PREPARED BY THE Office of the Legislative Counsel FOR THE USE OF THE U.S. HOUSE OF REPRESENTATIVES MAY 2010 VerDate 0ct 09 2002 14:17 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00001 Fmt 6012 Sfmt 6012 F:\P11\NHI\COMP\PPACFRN.001 HOLCPC June 9, 2010 f: \s e a ls \c o n g se a l.0 0 4 i OFFICE OF THE LEGISLATIVE COUNSEL SANDRA L. STROKOFF, Legislative Counsel EDWARD G. GROSSMAN, Deputy Legislative Counsel Prepared by EDWARD G. GROSSMAN, Deputy Legislative Counsel with the assistance of CRAIG A. STERKX, Publications Coordinator ELONDA C. BLOUNT, Staff Assistant EMILY M. VOLBERDING, Staff Assistant This document is of the Patient Protection and Affordable Care Act (‘‘PPACA’’; Public Law 111–148) consolidating the amendments made by title X of the Act and the Health Care and Education Rec- onciliation Act of 2010 (‘‘HCERA’’; Public Law 111–152). The text of the Indian Health Care Improvement Reauthorization and Ex- tension Act of 2009 (S. 1790), as enacted (in amended form) by sec- tion 10221 of PPACA, is shown in a separate, accompanying docu- ment. Preparation of document.—This document was prepared by the attorneys and staff of the House Office of the Legislative Coun- sel (HOLC) for the use of its attorneys and clients. It is not an offi- cial document of the House of Representatives or its committees and may not be cited as ‘‘the law’’. At the request of the Leader- ship, it is being made available to the public through Congressional websites and may be downloaded at http://docs.house.gov/ energycommerce/ppacacon.pdf. Errors in this document are solely the responsibility of HOLC. Please email any corrections to ‘‘[email protected]’’. This document (originally dated May 24, 2010) may be updated to reflect corrections of errors or subsequent changes in law. United States Code citations.—United States Code section numbers assigned to sections in PPACA are specified in brackets after the section numbers in the heading of each section, viz., 2711 ø42 U.S.C. 300gg–11¿. VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00001 Fmt 0486 Sfmt 6601 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 ii C O N T E N T S [For continuous pagination in electronic, PDF version, add 19 pages] Page Patient Protection and Affordable Care Act (Public Law 111–148) .................... 1 Sec. 1. Short title; table of contents .............................................................. 1 TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS Subtitle A—Immediate Improvements in Health Care Coverage for All Americans Sec. 1001. Amendments to the Public Health Service Act .......................... 13 Sec. 1002. Health insurance consumer information .................................... 27 Sec. 1003. Ensuring that consumers get value for their dollars ................. 28 Sec. 1004. Effective dates ............................................................................... 30 Subtitle B—Immediate Actions to Preserve and Expand Coverage Sec. 1101. Immediate access to insurance for uninsured individuals with a preexisting condition ................................................................................. 30 Sec. 1102. Reinsurance for early retirees ..................................................... 33 Sec. 1103. Immediate information that allows consumers to identify af- fordable coverage options ............................................................................. 36 Sec. 1104. Administrative simplification ...................................................... 37 Sec. 1105. Effective date ................................................................................. 44 Subtitle C—Quality Health Insurance Coverage for All Americans PART 1—HEALTH INSURANCE MARKET REFORMS Sec. 1201. Amendment to the Public Health Service Act ............................ 45 PART 2—OTHER PROVISIONS Sec. 1251. Preservation of right to maintain existing coverage .................. 55 Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and group health plans .................................................................... 56 Sec. 1253. Annual report on self-insured plans ............................................ 56 Sec. 1254. Study of large group market ........................................................ 57 Sec. 1255. Effective dates ............................................................................... 57 Subtitle D—Available Coverage Choices for All Americans PART 1—ESTABLISHMENT OF QUALIFIED HEALTH PLANS Sec. 1301. Qualified health plan defined ...................................................... 58 Sec. 1302. Essential health benefits requirements ...................................... 59 Sec. 1303. Special rules .................................................................................. 64 Sec. 1304. Related definitions ........................................................................ 68 VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00002 Fmt 0486 Sfmt 0486 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 Page iii PART 2—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH BENEFIT EXCHANGES Sec. 1311. Affordable choices of health benefit plans .................................. 69 Sec. 1312. Consumer choice ........................................................................... 80 Sec. 1313. Financial integrity ........................................................................ 83 PART 3—STATE FLEXIBILITY RELATING TO EXCHANGES Sec. 1321. State flexibility in operation and enforcement of Exchanges and related requirements ............................................................................. 85 Sec. 1322. Federal program to assist establishment and operation of non- profit, member-run health insurance issuers ............................................. 86 Sec. 1323. Community health insurance option østricken¿ ......................... 92 Sec. 1323. Funding for the territories ........................................................... 92 Sec. 1324. Level playing field ........................................................................ 93 PART 4—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS Sec. 1331. State flexibility to establish basic health programs for low- income individuals not eligible for Medicaid .............................................. 93 Sec. 1332. Waiver for State innovation ......................................................... 98 Sec. 1333. Provisions relating to offering of plans in more than one State ............................................................................................................... 100 Sec. 1334. Multi-State plans .......................................................................... 101 PART 5—REINSURANCE AND RISK ADJUSTMENT Sec. 1341. Transitional reinsurance program for individual market in each State ...................................................................................................... 105 Sec. 1342. Establishment of risk corridors for plans in individual and small group markets ..................................................................................... 108 Sec. 1343. Risk adjustment ............................................................................ 109 Subtitle E—Affordable Coverage Choices for All Americans PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS Sec. 1401. Refundable tax credit providing premium assistance for cov- erage under a qualified health plan ............................................................ 110 Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans ................................................................................................... 119 SUBPART B—ELIGIBILITY DETERMINATIONS Sec. 1411. Procedures for determining eligibility for Exchange participa- tion, premium tax credits and reduced cost-sharing, and individual responsibility exemptions ............................................................................. 123 Sec. 1412. Advance determination and payment of premium tax credits and cost-sharing reductions ......................................................................... 131 Sec. 1413. Streamlining of procedures for enrollment through an ex- change and State Medicaid, CHIP, and health subsidy programs ........... 133 Sec. 1414. Disclosures to carry out eligibility requirements for certain programs ........................................................................................................ 135 Sec. 1415. Premium tax credit and cost-sharing reduction payments dis- regarded for Federal and Federally-assisted programs ............................. 137 Sec. 1416. Study of geographic variation in application of FPL ................. 137 PART II—SMALL BUSINESS TAX CREDIT Sec. 1421. Credit for employee health insurance expenses of small busi- nesses ............................................................................................................. 138 VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00003 Fmt 0486 Sfmt 0486 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 Page iv Subtitle F—Shared Responsibility for Health Care PART I—INDIVIDUAL RESPONSIBILITY Sec. 1501. Requirement to maintain minimum essential coverage ............ 143 Sec. 1502. Reporting of health insurance coverage ...................................... 151 PART II—EMPLOYER RESPONSIBILITIES Sec. 1511. Automatic enrollment for employees of large employers ........... 154 Sec. 1512. Employer requirement to inform employees of coverage op- tions ................................................................................................................ 154 Sec. 1513. Shared responsibility for employers ............................................ 155 Sec. 1514. Reporting of employer health insurance coverage ..................... 159 Sec. 1515. Offering of Exchange-participating qualified health plans through cafeteria plans ................................................................................ 161 Subtitle G—Miscellaneous Provisions Sec. 1551. Definitions ..................................................................................... 164 Sec. 1552. Transparency in government ....................................................... 164 Sec. 1553. Prohibition against discrimination on assisted suicide ............. 164 Sec. 1554. Access to therapies ........................................................................ 165 Sec. 1555. Freedom not to participate in Federal health insurance pro- grams ............................................................................................................. 165 Sec. 1556. Equity for certain eligible survivors ............................................ 165 Sec. 1557. Nondiscrimination ........................................................................ 166 Sec. 1558. Protections for employees ............................................................. 166 Sec. 1559. Oversight ....................................................................................... 167 Sec. 1560. Rules of construction .................................................................... 167 Sec. 1561. Health information technology enrollment standards and pro- tocols .............................................................................................................. 168 Sec. 1562. GAO study regarding the rate of denial of coverage and en- rollment by health insurance issuers and group health plans .................. 170 Sec. 1563. Small business procurement ........................................................ 170 Sec. 1563 [sic]. Conforming amendments ..................................................... 171 Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility ........... 178 TITLE II—ROLE OF PUBLIC PROGRAMS Subtitle A—Improved Access to Medicaid Sec. 2001. Medicaid coverage for the lowest income populations ............... 179 Sec. 2002. Income eligibility for nonelderly determined using modified gross income .................................................................................................. 186 Sec. 2003. Requirement to offer premium assistance for employer-spon- sored insurance ............................................................................................. 190 Sec. 2004. Medicaid coverage for former foster care children ..................... 191 Sec. 2005. Payments to territories ................................................................. 191 Sec. 2006. Special adjustment to FMAP determination for certain States recovering from a major disaster ................................................................. 192 Sec. 2007. Medicaid Improvement Fund rescission ..................................... 193 Subtitle B—Enhanced Support for the Children’s Health Insurance Program Sec. 2101. Additional federal financial participation for CHIP .................. 194 Sec. 2102. Technical corrections .................................................................... 197 Subtitle C—Medicaid and CHIP Enrollment Simplification Sec. 2201. Enrollment Simplification and coordination with State Health Insurance Exchanges .................................................................................... 198 VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00004 Fmt 0486 Sfmt 0486 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 Page v Sec. 2202. Permitting hospitals to make presumptive eligibility deter- minations for all Medicaid eligible populations .......................................... 200 Subtitle D—Improvements to Medicaid Services Sec. 2301. Coverage for freestanding birth center services ......................... 201 Sec. 2302. Concurrent care for children ........................................................ 202 Sec. 2303. State eligibility option for family planning services .................. 203 Sec. 2304. Clarification of definition of medical assistance ......................... 206 Subtitle E—New Options for States to Provide Long-Term Services and Supports Sec. 2401. Community First Choice Option .................................................. 206 Sec. 2402. Removal of barriers to providing home and community-based services ........................................................................................................... 211 Sec. 2403. Money Follows the Person Rebalancing Demonstration ........... 214 Sec. 2404. Protection for recipients of home and community-based serv- ices against spousal impoverishment .......................................................... 215 Sec. 2405. Funding to expand State Aging and Disability Resource Cen- ters ................................................................................................................. 215 Sec. 2406. Sense of the Senate regarding long-term care ........................... 215 Subtitle F—Medicaid Prescription Drug Coverage Sec. 2501. Prescription drug rebates ............................................................. 216 Sec. 2502. Elimination of exclusion of coverage of certain drugs ............... 219 Sec. 2503. Providing adequate pharmacy reimbursement .......................... 220 Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments Sec. 2551. Disproportionate share hospital payments ................................. 223 Subtitle H—Improved Coordination for Dual Eligible Beneficiaries Sec. 2601. 5-year period for demonstration projects .................................... 224 Sec. 2602. Providing Federal coverage and payment coordination for dual eligible beneficiaries ..................................................................................... 225 Subtitle I—Improving the Quality of Medicaid for Patients and Providers Sec. 2701. Adult health quality measures .................................................... 227 Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions ..... 229 Sec. 2703. State option to provide health homes for enrollees with chron- ic conditions ................................................................................................... 229 Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization ............................................................................................... 233 Sec. 2705. Medicaid Global Payment System Demonstration Project ........ 235 Sec. 2706. Pediatric Accountable Care Organization Demonstration Project ............................................................................................................ 236 Sec. 2707. Medicaid emergency psychiatric demonstration project ............ 237 Subtitle J—Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC) Sec. 2801. MACPAC assessment of policies affecting all Medicaid bene- ficiaries .......................................................................................................... 239 Subtitle K—Protections for American Indians and Alaska Natives Sec. 2901. Special rules relating to Indians ................................................ 244 Sec. 2902. Elimination of sunset for reimbursement for all medicare part B services furnished by certain indian hospitals and clinics .................... 244 VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00005 Fmt 0486 Sfmt 0486 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 Page vi Subtitle L—Maternal and Child Health Services Sec. 2951. Maternal, infant, and early childhood home visiting programs 245 Sec. 2952. Support, education, and research for postpartum depression ... 255 Sec. 2953. Personal responsibility education ................................................ 258 Sec. 2954. Restoration of funding for abstinence education ........................ 263 Sec. 2955. Inclusion of information about the importance of having a health care power of attorney in transition planning for children aging out of foster care and independent living programs .................................. 264 TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE Subtitle A—Transforming the Health Care Delivery System PART 1—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM Sec. 3001. Hospital Value-Based purchasing program ................................ 266 Sec. 3002. Improvements to the physician quality reporting system ......... 277 Sec. 3003. Improvements to the physician feedback program .................... 279 Sec. 3004. Quality reporting for long-term care hospitals, inpatient reha- bilitation hospitals, and hospice programs ................................................. 282 Sec. 3005. Quality reporting for PPS-exempt cancer hospitals ................... 285 Sec. 3006. Plans for a Value-Based purchasing program for skilled nurs- ing facilities and home health agencies ...................................................... 286 Sec. 3007. Value-based payment modifier under the physician fee sched- ule ................................................................................................................... 288 Sec. 3008. Payment adjustment for conditions acquired in hospitals ........ 291 PART 2—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY Sec. 3011. National strategy .......................................................................... 293 Sec. 3012. Interagency Working Group on Health Care Quality ................ 295 Sec. 3013. Quality measure development ..................................................... 296 Sec. 3014. Quality measurement ................................................................... 300 Sec. 3015. Data collection; public reporting .................................................. 304 PART 3—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS Sec. 3021. Establishment of Center for Medicare and Medicaid Innova- tion within CMS ............................................................................................ 306 Sec. 3022. Medicare shared savings program ............................................... 313 Sec. 3023. National pilot program on payment bundling ............................ 318 Sec. 3024. Independence at home demonstration program ......................... 324 Sec. 3025. Hospital readmissions reduction program .................................. 328 Sec. 3026. Community-Based Care Transitions Program ........................... 333 Sec. 3027. Extension of gainsharing demonstration .................................... 335 Subtitle B—Improving Medicare for Patients and Providers PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES Sec. 3101. øIncrease in the physician payment update¿ørepealed¿ ........... 336 Sec. 3102. Extension of the work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule .................................................................................. 336 Sec. 3103. Extension of exceptions process for Medicare therapy caps ...... 338 Sec. 3104. Extension of payment for technical component of certain phy- sician pathology services .............................................................................. 338 Sec. 3105. Extension of ambulance add-ons ................................................. 338 Sec. 3106. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities .................................................................................................. 338 VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00006 Fmt 0486 Sfmt 0486 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 Page vii Sec. 3107. Extension of physician fee schedule mental health add-on ....... 338 Sec. 3108. Permitting physician assistants to order post-Hospital ex- tended care services ...................................................................................... 339 Sec. 3109. Exemption of certain pharmacies from accreditation require- ments ............................................................................................................. 339 Sec. 3110. Part B special enrollment period for disabled TRICARE bene- ficiaries .......................................................................................................... 340 Sec. 3111. Payment for bone density tests ................................................... 341 Sec. 3112. Revision to the Medicare Improvement Fund ............................ 342 Sec. 3113. Treatment of certain complex diagnostic laboratory tests ........ 342 Sec. 3114. Improved access for certified nurse-midwife services ................ 343 PART II—RURAL PROTECTIONS Sec. 3121. Extension of outpatient hold harmless provision ....................... 344 Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas ........................................................................................ 344 Sec. 3123. Extension of the Rural Community Hospital Demonstration Program ......................................................................................................... 344 Sec. 3124. Extension of the Medicare-dependent hospital (MDH) pro- gram ............................................................................................................... 345 Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals ........................................... 346 Sec. 3126. Improvements to the demonstration project on community health integration models in certain rural counties .................................. 346 Sec. 3127. MedPAC study on adequacy of Medicare payments for health care providers serving in rural areas .......................................................... 347 Sec. 3128. Technical correction related to critical access hospital serv- ices .................................................................................................................. 347 Sec. 3129. Extension of and revisions to Medicare rural hospital flexi- bility program ................................................................................................ 347 PART III—IMPROVING PAYMENT ACCURACY Sec. 3131. Payment adjustments for home health care ............................... 348 Sec. 3132. Hospice reform .............................................................................. 352 Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) payments ............................................................................................ 354 Sec. 3134. Misvalued codes under the physician fee schedule .................... 356 Sec. 3135. Modification of equipment utilization factor for advanced im- aging services ................................................................................................ 358 Sec. 3136. Revision of payment for power-driven wheelchairs ................... 359 Sec. 3137. Hospital wage index improvement .............................................. 360 Sec. 3138. Treatment of certain cancer hospitals ......................................... 362 Sec. 3139. Payment for biosimilar biological products ................................. 362 Sec. 3140. Medicare hospice concurrent care demonstration program ....... 363 Sec. 3141. Application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor ............................... 364 Sec. 3142. HHS study on urban Medicare-dependent hospitals ................. 364 Sec. 3143. Protecting home health benefits .................................................. 365 Subtitle C—Provisions Relating to Part C Sec. 3201. øMedicare Advantage payment¿ørepealed & replaced¿ ............. 365 Sec. 3202. Benefit protection and simplification .......................................... 370 Sec. 3203. øApplication of coding intensity adjustment during MA pay- ment transition¿ørepealed and replaced¿ ................................................... 372 Sec. 3204. Simplification of annual beneficiary election periods ................ 373 Sec. 3205. Extension for specialized MA plans for special needs individ- uals ................................................................................................................. 373 VerDate 0ct 09 2002 14:18 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00007 Fmt 0486 Sfmt 0486 F:\P11\NHI\COMP\PPACFRN.002 HOLCPC June 9, 2010 Page viii Sec. 3206. Extension of reasonable cost contracts ....................................... 376 Sec. 3207. Technical correction to MA private fee-for-service plans ........... 376 Sec. 3208. Making senior housing facility demonstration permanent ........ 376 Sec. 3209. Authority to deny plan bids ......................................................... 377 Sec. 3210. Development of new standards for certain Medigap plans ....... 377 Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and MA– PD Plans Sec. 3301. Medicare coverage gap discount program ................................... 378 Sec. 3302. Improvement in determination of Medicare part D low-income benchmark premium ..................................................................................... 386 Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under prescription drug plans and MA–PD plans ..................................... 386 Sec. 3304. Special rule for widows and widowers regarding eligibility for low-income assistance ............................................................................. 387 Sec. 3305. Improved information for subsidy eligible individuals reas- signed to prescription drug plans and MA–PD plans ................................ 387 Sec. 3306. Funding outreach and assistance for low-income programs ..... 388 Sec. 3307. Improving formulary requirements for prescription drug plans and MA–PD plans with respect to certain categories or classes of drugs 389 Sec. 3308. Reducing part D premium subsidy for high-income bene- ficiaries .......................................................................................................... 390 Sec. 3309. Elimination of cost sharing for certain dual eligible individ- uals ................................................................................................................. 393 Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in long-term care facilities under …