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The Health Care Law: An Update

The Health Care Law: An Update. Kenneth Munson, Regional Director U.S. Department of Health & Human Services, Region V. 6 Ways the ACA is Already Benefiting Americans. Providing new coverage options for young adults Ending denials of coverage to children because of pre-existing conditions

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The Health Care Law: An Update

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  1. The Health Care Law: An Update Kenneth Munson, Regional Director U.S. Department of Health & Human Services, Region V

  2. 6 Ways the ACA is Already Benefiting Americans Providing new coverage options for young adults Ending denials of coverage to children because of pre-existing conditions Requires health insurance plans and Medicare to cover recommended preventive services, including tests, screenings, and immunizations without charging co-pays/deductibles Restricts insurers’ use of annual and lifetime limits on coverage (bans them completely by 2014) Requires insurers to spend 80% to 85% of premium dollars on health care/quality improvements, not administrative costs/bonuses/salaries Requires insurers to justify any rate increase of 10% or more/new resources for states to review and block premium hikes

  3. Community Health Centers • $40.2 million for CHCs in Indiana since enactment of ACA • Latest rounds of funding (May and June, 2012) brought over $8 million to Indiana CHCs: • $650,000 for Vermillion-Parke Community Health Center in Clinton • $650,000 for Maple City Health Care Center in Goshen • $1,055,000 for Healthnet, Inc. in Indianapolis • $437,000 for Windrose Health Network, Inc. in Trafalgar • $5,275,930 for Healthlinc, Inc. in Valparaiso

  4. The Innovation Center – Revitalizing Primary Care • Comprehensive Primary Care Initiative • 75 primary care practices, serving approximately 44,500 beneficiaries participating in Region V • Federally Qualified Health Center Advanced Primary Care Practice Demonstration • Cass County Community Health Center, • Community Health Center of Jackson County, HealthLinc, Inc., • Heart City Health Center, • Indiana Health Centers at Kokomo, • Indiana Health Centers at South Bend, • and Vermillion-Parke Community Health Center are participating

  5. The Innovation Center – Encouraging Care Coordination • Accountable Care Organizations (ACOs) • Medicare Shared Savings Program for ACOs • Advanced Payment ACOs • Pioneer ACOs • Bundled Payments for Care Improvement • Retrospective Bundled Payments • Prospective Bundled Payments • Financial Models to Support State Efforts to Integrate Care for Medicare-Medicaid Enrollees/”Dual Eligibles”

  6. Investments in Electronic Health Records • EHR technology creates better-coordinated & more efficient care, which leads to safer & higher-quality care • Reduced medical errors • Reduced redundant tests & procedures • Better availability of records & data • Improved clinical decision support • Improved safety & convenience of electronic prescribing • The HITECH Act created financial incentives for providers who adopt EHRs • 176,049+ providers registered for the Medicare & Medicaid EHR incentive programs • $30 million in supplemental grant funds for RECs targeting CAHs

  7. Expanding Access to Insurance States have the option to expand Medicaid to cover families with income up to 133 percent of the poverty level Single adults will be eligible as well as families with children Maximum annual income of: $14,856 for 1 person $30,656 for a family of 4 NEJM study (August 2012): for every 176 adults covered under expanded Medicaid, one death per year would be prevented 2,840 deaths per year were prevented for every 500,000 people who received additional Medicaid coverage

  8. Exchange Establishment All States have the option to establish a State-based Exchange. In States where a State-based Exchange is not operating, HHS will operate a Federally-facilitated Exchange (FFE) or in a State Partnership. • States with approved or conditionally approved State-based Exchanges move towards full operation by initial open enrollment period, October 1, 2013. • State submits an Exchange Blueprint to HHS and demonstrates operational readiness. • January 1, 2013 • HHS approves or conditionally approves Exchange Blueprints. • States without approved Blueprints will have a Federally-facilitated Exchange in 2014, but can seek approval in subsequent years. • States can partner with HHS to operate some functions and seek approval to operate a State-based Exchange in subsequent years. • State does not elect to operate an Exchange.

  9. Learn More HealthCare.gov Social Networks Email: Kenneth.Munson@hhs.gov

  10. Reminder: Medicare Open Enrollment runs from October 15 to December 7 this year!

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