Straight talk on health care reform January 1 a milestone as many provisions kick in
On Jan. 1, eleven provisions of the Patient Protection and Affordable Care Act – that is, the national health care reform law – will go into effect. Here are some of the provisions (click here for a complete list and details on funding mechanisms):
Minimum medical loss ratios for health insurers
Health plans will be required to report the percentage of every premium dollar spent on clinical services and ensuring clinical quality for plan year 2010. If plans spend below a certain amount (85 percent for the large-group market and 80 percent for the individual and small-group markets), those health plans will be required to provide rebates to consumers.
Prevention and wellness benefits
The new law authorizes Medicare coverage for preventive care and wellness planning, including a comprehensive health risk assessment. It will establish a cost-sharing program for many Medicare-covered preventive services. The law also waives the Medicare deductible payment for colorectal cancer screening.
Voluntary long-term community-living insurance
The law will establish a voluntary insurance program for purchasing long-term community-living assistance services and supports, also known as the "CLASS Program." This will provide up to $50 daily to help individuals purchase non-medical services necessary to maintain a community residence. The program is financed through voluntary payroll deductions; unless they opt out, all working adults will be enrolled in the program.
Medical 'homes' for Medicaid
Reforms will create a new state option that will allow some Medicaid beneficiaries to identify a provider as a "health home." Under a health home, a patient chooses a physician who then leads a medical team that manages care ranging from specialists to pharmacists; such programs are designed to engage patients in their own care and have been found to provide optimal health care. States that take up the option will receive 90 percent in federal matching funds for two years to finance the program.
Medicaid chronic-disease prevention
The law provides a three-year grant to states to develop programs that will encourage Medicaid enrollees to participate in lifestyle-improvement programs and to meet health-behavior goals.
Innovation and health care quality
The law creates a Center for Medicare and Medicaid Innovation to test payment and delivery system models. These models must reduce costs while either maintaining or improving quality.
Medicare premiums for higher-income individuals, couples
In order to fund some of these benefits, income thresholds for Medicare Part B premiums will be frozen at 2010 levels for eight years. This will result in more beneficiaries paying income-related premiums. Also, the Medicare Part D premium subsidy will be reduced for individuals with incomes above $85,000 and couples making more than $170,000.