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AL 254 Part 4

Health Care Reform

QuestionAnswer
What does the Affordable Care Act of 2010 do? expands coverage to uninsured americans, makes changes to current health care system, aims to improve coordination of care and patient outcomes, costs to be offset by new taxes and other revenues.
Individual Health Insurance Mandate Starting in January 2014, most people will be required to have health insurance or pay an annual penalty of $695 per person. Penalty will be phased in gradually from 2014-2016. Employees who do not use employer based coverage are eligible for tax credit.
Individual Mandate Exceptions Financial hardship, religious objections, Native Americans, people uninsured fewer than 3 months, undocumented individuals, incarcerated individuals, income below tax filing threshold, if lowest cost plan exceeds 8% of income.
Employer Mandates Employers with > 50 employees will pay penalties for employees receiving credits through exchange. Employers with < 200 employees must automatically enroll employees into health insurance plans offered by the employer. Employees may opt out of coverage.
Employer Related Issues verification of income and citizenship is required to receive tax credit. Tax credit for small businesses.
Medicaid Expansion Medicaid will expand to individuals under age 65 with income less than 133% FPL. Newly eligible individuals will receive health benefits package. Medicaid expansion is optional for some states.
CHIP Expansion CHIP funding extended and federal match increased. Families with children who are eligible but unable to enroll due to enrollment caps receive tax credit.
Health Insurance Exchanges Individual without access to affordable employer-based insurance can purchase health insurance through a state exchange, credits available to families 400% FPL, will provide consumers with information about various plans.
Changes to Insurance Regulations Guranteed issue and renewability, rating variability limited to age, family composition and tobacco use. New taxes imposed on the insurance and pharmaceutical companies.
Changes to Insurance Regulations Part 2 Temporary high risk pool, essential health benefits, limits on abortion coverage, medical loss ratio and consumer rebates, process for justifying rate increases, eliminates lifetime limits and annual limits, children can stay on parents plan until 26.
Essential Benefits Ambulatory patient services, emergency services, hospitalization, newborn and maternity care, mental health and substance abuse disorder treatments, prescription drugs, rehabilitative and habilative services, laboratory services, wellness/disease.
Changes in Delivery and Payment for Care will first be implemented through Medicare.
Postacute care bundling uses a single payment for all treatment related to a specific condition or treatment
Accountable care organizations (ACO's) groups of providers who share responsibility for quality and cost of care across multiple settings.
Medical Home Models team approach with the physician as the leader, to coordinate care throughout the stages of a disease across the lifespan.
Focus on Prevention and Wellness Grant program to support the delivery of evidence based and community based prevention and wellness, support for employee wellness programs.
Community Based Care Community First Choice Option in Medicaid, New options for offering home and community based services to replace Medicaid waivers, Sate Balancing Incentive Program to increase non-institutional long term services.
Opportunities for OT Focus on wellness and preventive services, Mandatory benefits package includes rehabilitative and habilitative services and also mental health services.
Challenges for OT Potential decrease in reimbursement, Advocacy will be essential.
Created by: lcurtis