The Affordable Care Act (ACA) is a landmark health care reform law that aims to lower health care costs and improve coverage for all Americans. This law holds insurance companies accountable for how they spend premium dollars and increase rates, and provides tax credits and marketplaces to help reduce costs. It also sets guidelines for insurers to spend at least 80 percent of premium dollars on medical care. If insurers don’t meet these standards, the act requires them to pay rebates to consumers.
Sec. 1515) Prohibits penalty from being imposed upon an individual, company, business, nonprofit entity, or health insurance issuer
The ACA prohibits states from applying restrictive eligibility requirements for the CHIP program. The law also requires the Secretary of the Treasury to disclose taxpayer information to HHS personnel. Among other things, the ACA requires Exchanges to provide qualified health plans that are comparable to state-sponsored health insurance programs. The act also prohibits states from offering enrollment bonus payments to children who qualify for coverage under the CHIP program.
Under Sec. 1515, a health care collaborative may establish a board of directors consisting of physician-members who are selected by the person who established the collaborative. The board’s initial members shall serve 18-month terms. After that, subsequent board members shall be elected by the participating physicians and health care providers for two-year terms. The board shall elect a chair from among its members.
The Act also requires large employers to file reports with the Secretary of the Treasury regarding health insurance coverage. The Act’s provisions also prohibit the Secretary of Health and Human Services from promulgating regulations that prevent patients from receiving full disclosure about their condition. Moreover, the Act prohibits health insurers from denying coverage to individuals because they are uninsured or don’t have adequate health insurance coverage.
The Act enacted changes to the Medicaid program and the Medicare program. The Act also amends title XIX (Medicaid). It enables states to provide Medicaid coverage to individuals under 65 without Medicare and with incomes less than 133% of the federal poverty level. The law allows states to expand Medicaid coverage to these individuals as early as April 1, 2010. Starting in 2014, the federal government will pay for those newly-eligible individuals.
The ACA also requires health plans to implement an effective appeals process. In addition, the ACA requires health plans to provide coverage for emergency services and eliminate referral requirements for gynecological care. The Act also requires the Secretary to provide grants to states to support consumer assistance programs.
Sec. 1515) Prohibits penalty from being imposed upon an individual, company, business, nonprofit entity, or health insurance issuer for failure to comply with ACA regulations. The Act also makes a number of other changes to the program. For example, the Act requires health plans to use uniform dispensing techniques for part D drugs to reduce waste associated with 30-day refills. Furthermore, the Act directs the Secretary to develop an effective complaint process for consumers.
In addition to the ACA’s penalties, the law also contains provisions that promote the development of innovative patient care models. The Affordable Care Act creates the Center for Medicare and Medicaid Innovation, which is charged with testing innovative payment and service delivery models. And it requires hospices and long-term care hospitals to report data on specified quality measures starting in 2014. Furthermore, the Act reduces the annual update of entities that don’t comply with this provision.
The ACA also restricts health plans from imposing eligibility criteria based on health status. These factors include the type of disease a person has, the number of previous hospitalizations, and the type of treatment he or she has received. The ACA also prevents health plans from imposing cost sharing on preventive care and recommended immunizations. It also prohibits discrimination against licensed providers.
Sec. 1516) Amends SSA title XVIII to deem eligible for Medicare coverage
The Secretary of Health and Human Services shall provide information about the benefits of Medicare supplemental insurance plans and supplementary policies to eligible individuals. This information shall be provided by a toll-free telephone number. This section shall not affect the guaranteed renewability of coverage under a part D plan.
The act amends the Social Security Act to provide hospital insurance benefits to the elderly. It also expands coverage under the Old-Age, Survivors, and Disability Insurance System and makes federal-state public assistance programs more efficient. It also requires the Secretary to transfer funds from the trust funds to the CMS PMA and waives the requirement for budget neutrality for the pilot program.
Under the new law, a person can buy Medicare supplemental insurance policies as long as they meet certain criteria. For example, the plan must have a provision that suspends premiums and benefits if the policyholder is not receiving benefits. Furthermore, the policyholder must notify the insurer within 90 days of receiving the notice that the policy will not provide benefits.
The policyholder’s medical supplemental insurance policy may be replaced by another group medicare supplemental insurance policy. However, the replacement policy must offer coverage to all covered individuals on the termination date of the group medicare supplemental policy. In addition, the new policy cannot exclude coverage for a preexisting condition.
Pub. L. 108-203 directed the amendment of this section. It replaced the previous provisions by inserting subpar. (A) and (B) as part of the concluding provisions. The amendment also added the designation “Commissioner of Social Security” in the second sentence. The new section now refers to the Commissioner of Social Security as the probable intent of Congress.
The Act also requires the insurance provider to disclose the terms “coordinated” and “excluded” in the policy outline. These terms refer to policies that are secondary to other health insurance plans and exclude coverage of specific items.
A medicare supplemental insurance policy issuer may obtain genetic information from an individual as a part of the payment determination. Genetic information must be obtained only when necessary to accomplish the purpose. It is not permitted to obtain genetic information for underwriting purposes prior to enrollment.
Sec. 1517) Amends SSA title XX to direct the Secretary to establish a program for early detection of certain medical conditions related to environmental health hazards
This section requires state units to collect personal information about the individual for purposes of program administration. This includes health and psychological information. However, the State unit may only release the information to another agency or organization with written consent. The State unit may also disclose the information to the individual or an authorized representative.
This section prohibits discrimination in health care services, which includes gender and sex. In addition, it requires states to develop civil rights policies and provide training to employees. It also requires health insurance issuers to provide notice about available services.
This section also directs the Secretary to establish a program for early diagnosis of certain medical conditions associated with environmental health hazards. The program is intended to improve the health of the population. The program will provide early detection of certain medical conditions that could lead to premature death.
The Act also requires the establishment of a patient management plan for Medicaid-eligible Native Americans. The program must also coordinate services and consult with Indian tribes and Indian health programs in participating counties.
In addition to these provisions, this Act requires VRs to keep records confidential. However, they cannot disclose any information about their customers to the public without their consent. Furthermore, they are required to retain a copy of the official certificate and a description of the records. Further, it requires the parties involved in the hearing process to conduct themselves with respect and professionalism. The parties can cross-examine witnesses and present rebuttal evidence. In addition, they can also request judicial review.
In 2001, the U.S. Supreme Court ruled that Title VII of the U.S. Code prohibited discrimination in employment because of sex, gender identity, or sexual orientation. The program also provides wraparound services for enrollees.
The program must also be conducted in conjunction with the Secretary of Health and Human Services. The program must be accompanied by adequate documentation, including medical records and physician notes. The Secretary should also establish a referral mechanism to coordinate health care.
The program must also provide a system to protect enrollees from exploitation or abuse. These include critical incident monitoring and investigation of incidents and the linking of enrollees to protective services.
The program must be conducted in compliance with federal law and regulations. In addition, changes in federal law may require state legislation. However, the changes must take effect the day after the federal law becomes effective. Unless the amendment is approved by CMS, the changes will not be retroactive. If the changes are made after the demonstration approval period, the state may not qualify for FFP.
The program also requires states to conduct a needs assessment of the beneficiaries. The process should include a standardized assessment tool that is approved by the state. States should use this tool to ensure timely assessment of LTSS requests.