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


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


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


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.


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


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


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


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


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


3/31

1201 +

10103RECON


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


Services Act

Insurers must accept everyone who applies for coverage. 2014

1201


Public Health

Services Act

Insurers must renew coverage for everyone who has it. 2014

1201


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


If a doctor or hospital is willing to work with an insurer, the

insurer has to let them.2014

1201


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


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


4/31


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.


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.


7/31

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)


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


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


The Federal Government, States, and insurers cannot

discriminate against doctors and hospitals that refuse to doassisted suicide.


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.


Services Act

Health insurance programs benefiting from Federal credits andsubsidies cannot discriminate against anyone based on age,

gender, race, etc.


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.


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.


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


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


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.


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.


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).


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.


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.


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.


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


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.


Security Act

Extends reimbursement to Native American Indian hospitals

under Medicare Part B, previously due to expire in 2010.


14/31

2951


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.


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


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


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


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


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.


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


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


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.


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


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


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


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.


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


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


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


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


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


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.


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.


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.


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


Adjustment of costs forMedicare Advantage servicescontinues on a yearly basis (prior to HCERA, it only continueduntil 2010).


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.


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.


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.


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


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


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


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


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


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.


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


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


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


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


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


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


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


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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



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.


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.


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


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)


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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."


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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


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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

breakdown of patient protection & affordable care act (titles i, ii, iii, xiii)

Documents