Affordable Care Act Nurse Practitioner Association of Southwestern Pennsylvania May 15, 2013

1. HEALTHCARE.GOV Affordable Care ActNurse Practitioner Association of Southwestern Pennsylvania May 15, 2013 Aryanna Abouzari, Esq. Executive Officer U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia

3. Critical Need for Health Reform 48.6 million uninsured Americans $3 trillion spent annually on healthcare 17.9 % of our economic output tied up in the health care system Without reform, by 2040, 1/3 of economic output tied up in health care

4. Affordable Care Act Overview • Creates Consumer Protections • Prevents denials of coverage for pre-existing conditions • Make health insurance more affordable for middle class families and small businesses with tax credits • Expands access to care through Marketplaces and Medicaid expansion

5. Highlights for Providers • Increases the number of Primary Care Practitioners – Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants • Projected to place more than 16,000 health professionals over next 5 years • Community Health Centers - Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years • 231 community health centers in PA eligible for funding • 671,646 patients treated in 2010 at federally supported health centers in the U.S.

6. Highlights for Nursing Workforce Nurse Education, Practice, Quality & Retention Nursing Workforce Diversity Nurse Faculty Loan Program Advanced Nursing Education Program Advanced Education Nursing Traineeships Nurse Anesthetist Traineeships

7. Center for Medicare and Medicaid Innovation • Developing payment and delivery system reforms, focused on: • Expanding team-based care coordination • Rewarding providers for care outside of traditional face-to-face visits • Focusing on aggressive management of chronically ill patients • Expanding access to home-based care • $10 billion in funding for FY 2011 - 2019 • Opportunity to scale up: authority to expand successful models to the national level

8. Center for Medicare and Medicaid Innovation Partnership for Patients Accountable Care Organizations Bundled Payments for Care Improvement Community-based Care Transitions Program Value Based Purchasing Graduate Nurse Education Demonstration

9. Health Insurance Marketplace • Sometimes called “Exchanges,” the Marketplace is required by the ACA to be created by January 1, 2014 • New “marketplace” where small businesses and individuals can select and enroll in a private health insurance plan • Consumers will have • the same level of benefits and coverage available to members of Congress • more choice and selection in health plans

10. Marketplace Implementation • Three models available • State-Based • Federal-State Partnership • Federally-Facilitated • States can apply for Marketplace establishment funding at any time and be awarded grants through 2014 • HHS to operate marketplaces for States that have not elected to do so

11. Health Insurance Marketplace Regional Snapshot • PA– No enabling legislation; Federally-facilitated • DE – No enabling legislation; Federal-State Partnership • MD – Passed enabling legislation; State-based • DC – Passed enabling legislation; State-based • WV – Passed enabling legislation; Federal-State Partnership • VA – No enabling legislation; Federally-facilitated

12. Financial Assistance • Premium tax credits • Will reduce the premium amount the consumer owes each month • Available to eligible consumers with household incomes between 100% and 400% of the FPL ($44,680 for an individual and $92,200 for a family of 4 in 2012), and who don’t qualify for other health insurance coverage • Based on household income and family size for the taxable year • Paid each month to the insurer

13. Financial Assistance • Cost-sharing reductions: • Reduce out-of-pocket costs (deductibles, coinsurance, copayments) • Generally available to those with income 250% FPL or below ($27,925 for an individual and $57,625 for a family of 4 in 2012) • Consumer must enroll in a “silver-level” plan

14. Quality Insurance • The ACA requires plans inside the Marketplace to meet particular actuarial value (AV) targets • Bronze = 60% AV • Silver = 70% AV • Gold = 80% AV • Platinum = 90% AV • “Metal Levels” will enable consumers to compare plans with similar levels of coverage, promote competition on premiums, and allow plans flexibility to design cost sharing structures

15. Quality Insurance • Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services/devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

16. Enrollment Process • Consumer submits application to the marketplace • Online • Phone • Mail • In Person • The marketplace verifies and determines eligibility for • enrollment in a Qualified Health Plan (QHP) • tax credits and cost-sharing reductions • Medicaid or CHIP • Consumer enrolls in a QHP or Medicaid/CHIP • Online plan comparison tool available to inform health plan choice • Tax credit is sent to insurer (if eligible) to reduce consumer premium owed

17. Enrollment Assistance • Help available in each Marketplace • Toll-free call center • Website • Navigator program • Certified Application Counselors • Community-based organizations • Agents and brokers

18. Initial Open Enrollment Period • October 1, 2013 – March 31, 2014

19. Affordable Care Act website –www.healthcare.gov Health Insurance Marketplace – marketplace.cms.gov Center for Consumer Information & Insurance Oversight website – http://cciio.cms.gov Affordable Care Act Spanish website – www.cuidadodesalud.gov Resources:

20. Thank you! Contact: aryanna.abouzari@hhs.gov