Important Information from BUA on Healthcare Reform
03-23-2010
To accomplish the objective of near-universal health coverage, the health reform package carries incentives in the form of tax credits and a penalty for those individuals choosing to remain uninsured, a penalty for larger employers that don't offer health insurance coverage, and tax credits for small employers that do offer coverage. Many provisions do not take effect for several years. However, the following provisions will have impact in 2010:
* Effective within 90 days of enactment and extending through Jan. 1, 2014, a temporary national high-risk pool is established to provide health coverage to individuals with pre-existing medical conditions. Individuals who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums. Premiums for the pool will be established for a standard population and may vary by no more than 4 to 1 due to age; maximum cost-sharing will be limited to the current law HSA limit ($5,950/individual and $11,900/family in 2010).
* Effective in 2010, health insurance plans are required to report the proportion of premium dollars spent on clinical services, quality, and other costs. Effective in 2011, insurers must provide rebates to consumers for the amount of the premium spent on clinical services and quality that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets. A process is established for reviewing increases in health plan premiums and requiring plans to justify increases. States are required to report on trends in premium increases and recommend whether certain plan should be excluded from the Exchange based on unjustified premium increases.
* Effective six months after enactment, all individual and group policies must provide dependent coverage for children through age 26; individual and group health plans are prohibited from placing lifetime limits on the dollar value of coverage and insurers are prohibited from rescinding coverage except in cases of fraud; plans are prohibited from imposing pre-existing condition exclusions for children.
* Several provisions link quality outcomes and payments under Medicare. Quality measure reporting programs, already in place for inpatient acute hospitals, will be developed for long-term care hospitals, rehabilitation hospitals, hospice programs, and PPS-exempt cancer hospitals.
* Reimbursement for most types of Medicare providers will be adjusted to improve payment accuracy. Medicare Advantage payments will be adjusted to be more in line with Medicare fee-for-service payments.
* Payments under the Physician Fee Schedule will increase by 0.5 percent increase over 2009 rates.
* Provisions to prevent fraud in federal healthcare programs and to increase the program integrity of both Medicare and Medicaid will be implemented.
With changes anticipated, we will update you as the conglomerate of healthcare legislation works its way through Congress. In the meantime, if you have any questions please contact BUA.
