National Consumers League


NCL Health Issues

New changes for 2011 in health care

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What's new with the Affordable Care Act for 2011?More than 20 new provisions of the Affordable Care Act took effect with the new year. Which ones will affect you and your family, and which ones will not come to be until 2014? Get to know the Affordable Care Act.

While many important consumer-oriented pieces are being implemented now, a majority of the law – including the controversial insurance mandate – will not take effect until 2014. Provisions that will directly benefit consumers include the medical loss ratio requirement, which ensures that health plans spend most of consumers’ money directly on health care-related expenses and will encourage greater transparency in health plan rates, as well as continued progress towards closing the Medicare Part D coverage gap.

Medicare beneficiaries will be glad to know that they will no longer be required to pay a co-payment for Medicare-covered preventive services, such as flu shots and annual screenings that are recommended by the US Preventive Services Task force. And beginning March 23 of this year, chain restaurants and vending machines will be required to disclose the nutritional content of standard food items.

In addition, several new Centers and Institutes will be created this year to help promote quality and prevention, and work towards getting better access to coverage and care for millions of Americans.

More about the provisions

Minimum Medical Loss Ratio for Insurers – if individual and small group health plans spend less than 80 percent (and large groups less than 85 percent) of premiums on health care services, they must provide rebates to consumers.

Closing the Medicare Drug Coverage Gap – Pharmaceutical manufacturers are now required to provide a 50 percent discount on brand name drugs covered under Medicare Part D. Manufacturers not participating will no longer see their drugs covered under Part D. Federal subsidies for generic prescriptions filed under Part D will also begin this year. Eligible Medicare enrollees received $250 checks last summer as well to help close the coverage gap (or “donut hole”).

Medicare Premiums for Higher-Income Beneficiaries – The income threshold for income-related Medicare Part B premiums will remain at 2010 levels through 2019; this will directly result in more people paying income-related premiums and will reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Medicare Prevention Benefits - Medicare participants will no longer be required to pay for Medicare-covered preventive services that are recommended by the US Preventive Services Task force. In addition, deductibles for colorectal cancer screening tests will now be waived. Medicare will now also cover personalized prevention plans, which can include a comprehensive health risk assessment.

Medicare Payments for Primary Care – Primary care services will receive a 10 percent Medicare bonus payment. Additionally, general surgeons practicing in areas where there are health care practitioner shortages will also qualify for a 10 percent Medicare bonus payment.

Center for Medicare and Medicaid Innovation – This new Center was established on January 1, 2011 to test new payment and delivery system models that reduce costs while maintaining or improving quality.

CLASS Program – The CLASS Program establishes a national, voluntary insurance program for purchasing community living assistance services and supports.

Medicare Advantage Payment Changes – Payments to private Medicare Advantage plans will be restructured by phasing-in payments at increasingly smaller percentages of Medicare fee-for-service rates. Medicare Advantage plans will be prohibited from imposing higher cost-sharing requirements from some Medicare covered benefits than is required under the traditional fee-for-service program.

Medicaid Health Homes – A new health home option will be available to certain Medicaid enrollees; eligible consumers will be able to designate a provider as their health home. Participating states can receive 90% matching payments for two years for all health home-related services.

Chronic Disease Prevention – Participating states can receive 3-year grants to develop programs for Medicaid enrollees that incentivize participation in comprehensive health and wellness programs and achievement of certain health behavior targets.

Tax-Free Savings Accounts – Beginning January 1, 2011, consumers are now required to have prescriptions for their over-the-counter products they wish to have reimbursed through a Flexible Spending Account or Health Savings Account.

National Quality Strategy – The Secretary of Health and Human Services is required to develop and update, annually, a national quality improvement strategy. Specific priority areas for improvement include health care delivery, patient health outcomes, and population health.

Grants to Establish Wellness Programs – Small employers can seek grants (for up to five years) to establish wellness programs.

Teaching Health Centers – Funding is available to establish Teaching Health Centers and to provide payment for primary care residency programs and community-based ambulatory patient care centers.

Medical Malpractice Grants – Funding is available ($50 million for five-year demonstration grants) for states to develop, implement, and evaluate alternatives to current tort litigations.

Funding for Health Insurance Exchanges – Grants will be awarded beginning in March for states to begin planning for the establishment of the American Health Benefit Exchanges and Small Business Health Options Program exchanges.

Nutritional Labeling – Beginning March 23, 2011, chain restaurants and vending machines will be required to disclose the nutritional content of standard food items.

Medicaid Payments for Hospital-Acquired Infections – Effective July 1, 2011, federal payments will be prohibited to states for Medicaid services related to certain hospital-acquired infections. This aims to help improve patient health outcomes.

Graduate Medical Education – In July, the number of Graduate Medical Education (GME) training positions will increase. Currently unused slots will be redistributed, and there will be a greater emphasis on training in outpatient settings.

Medicare Independent Payment Advisory Board – The Independent Advisory Board will begin receiving funding in October. The Board will consist of 15 members and will submit legislative proposals with recommendations to curb Medicare spending, if spending exceeds targeted growth rates.  Recommendations are not due until January 2014.

Medicaid Long-Term Care Services – In October, the State Balancing Incentive Program in Medicaid will be created to provide enhanced matching payments to increase non-institutionally based long-term care services. It will also establish the Community First Choice Option in Medicaid, which will provide community-based attendant support services to certain people with disabilities.