An Internist's Practical Guide to Understanding Health System Reform

This Guide is intended to serve as a practical resource for internists on health system reform legislation, the Patient Protection and Affordable Care Act (ACA), enacted in March 2010. The Guide is organized by the year in which a policy issue is to be implemented, making it easily apparent which new policies may be impacting physicians/patients immediately. Simply click on the policy provision of interest, in any given year, to find a summary of that provision of law, in an easy "frequently-asked-questions" format. Additional resources and information on each topic are also included in each summary.

*Updated October 2013.

Table of Contents

I. Introduction

• Summary of Key Health System Reforms Affecting Patients and Key Provisions of Health System Reform Affecting Internists
• How is the Patient Protection and Affordable Care Act (ACA) Funded?

II. 2010 Reforms

• Small Business Tax Credit - 2010
• New Requirements for Health Insurers - 2010
  • Coverage for Dependents up to Age 26
  • Temporary High-Risk Pools
  • Pre-existing Conditions Exclusions Banned for Children
  • Restricting Annual or Lifetime Dollar Limits on Coverage
  • Prohibiting Coverage Rescissions
  • Justifying Premium Increases
  • Covering Core Preventive Services
  • Option for Early Medicaid Coverage Expansion
• Rebates through Medicare's Prescription Drug Program
• National Health Care Workforce Commission
• Teaching Health Centers
• Loan and Scholarship Programs under Title VII
• Changes to Primary Care Training Programs - Title VII, Section 747
• Time Spent By Residents in Non-hospital Settings
• State Loan Repayment Tax Exclusion
• Comparative Effectiveness Research
• Centers for Medicare & Medicaid Innovation
• Community Health Teams to Support the Patient Centered Medical Home
• Identifying and Correcting Mis-Valued Services Paid Under the Medicare Physician Fee Schedule
• Technical Component Discounts for Advanced Imaging Services
• Medical Liability Reform - Free Clinics and Medical Liability Immunity

III. 2011 Reforms

• Prescription Drug Discounts and Medicare
• Refunds for Excessive Health Insurance Premiums
• National Health Service Corps
• Redistribution of Graduate Medical Education Slots
• Primary Care Extension Programs
• Medicare Bonus Payment for Primary Care Services
• Medicaid Health Homes for Enrollees with Chronic Conditions
• Medicare-Covered Preventive Services
• Medicare Pay-for-Reporting Program
• Community-Based Collaborative Care Networks Grant Program
• Advanced Imaging Service Assumed Equipment Use Rate
• Medical Liability Reform - Demonstration Grants

IV. 2012 Reforms

• Quality Reporting Requirements for Group and Individual Insurers
• Medicare Shared Savings (Accountable Care) Program
• Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2012

V. 2013 Reforms

• Enhanced Medicaid Reimbursement Rates for Primary Care Services
• National Pilot Program on Payment Bundling
• Prescription Drug Discounts and Medicare - 2013
• Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2013

VI. 2014 Reforms

• Health Insurance Exchanges
• Health Insurance Tax Credits for Individuals and Families
• Small Business Tax Credits - 2014
• Medicaid Coverage Expansion
• New Requirements for Health Insurers - 2014
  • Guaranteed Issue and Renewability
  • Premiums Cannot be Based on Enrollee Health Status
  • Universal Prohibition on Pre-Existing Condition Exclusions
  • Universal Prohibition on Annual Dollar Limits on Coverage
  • Eliminate Coverage Waiting Periods
  • Essential Benefits Package
• Tax Penalties for Individuals Who Do Not Purchase Coverage
• Employer-Based Wellness Programs
• Income-Based Repayment for Student Loans
• Advanced Imaging Service Assumed Equipment Use Rate
• Independent Payment Advisory Board
• Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2014

VII. 2015 Reforms and Beyond

• Payment Penalties under Medicare's Pay-for-Reporting Program
• Value-Based Payment Modifier
• Simplifying Administrative Requirements the Health Care System Imposes on Physicians - 2016

VIII. Conclusion