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Affordable Care Act Title IV

An overview of Title IV of the Affordable Care Act, which focuses on preventing chronic disease and improving public health through modernizing systems, increasing access, and supporting innovation.

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Affordable Care Act Title IV

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  1. Affordable Care Act Title IV Prevention of Chronic Disease and Improving Public Health Healthcare Policy CPT Jimmie Beheler, CPT Max Smith, CPT Ted Walker 29 January 2015 • Graduate Students, U.S. Army-Baylor MBA/MHA Program

  2. The Affordable Care act“A Commercial” • http://www.motherjones.com/mojo/2013/07/funny-or-die-obamacare-white-house-mike-farah • http://www.luckplan.com/ • LESS THAN 90 Seconds

  3. Agenda • Title IV - Overview • Purpose • Contents • Amendments to other legislation • Subtitles • A – Modernizing Disease Prevention and PublicHealth Systems • B – Increasing Access to Clinical Preventive Services • C – Creating Healthier Communities • D – Support for Prevention and Public Health Innovation • E – Miscellaneous Provisions

  4. Title iv – overview • Purpose • Prevention of Chronic Disease & Improvement of Public Health • ACCESS & PREVENTION • Themes • Modernizing Systems • Increasing Access • Community Focused • Support for Innovation • Contents • Governing Body / Leadership / Task Forces • Strategy Development / Reports to Congress • National Media Outreach & Education Campaigns • Funding & Grants • Amendments to Major Legislation • Rehabilitation Act of 1973 • Federal Food, Drug, and Cosmetic Act • Fair Labor Standards Act of 1938 • Public Health Service Act • Social Security Act

  5. Subtitle A - Modernizing Disease Prevention and Public Health Systems • Sec. 4001. National Prevention, Health Promotion and Public Health Council. • National Prevention, Health Promotion and Public Health Council • DHHS activity • Chair – Surgeon General • Council members – Federal Government Department and agency heads • National Prevention, Health Promotion, and Public Health Strategy

  6. Subtitle A - Modernizing Disease Prevention and Public Health Systems • Sec. 4002. Prevention and Public Health Fund. • $5 billion (FYs 2010-2014), $2 billion per FY thereafter • To curb growth rate of health care costs (private and public) • Public Health Service Act Programs Supported: • Community Transformation grant program • Education and Outreach Campaign for Preventive Benefits • Immunization programs

  7. Subtitle A- Modernizing Disease Prevention and Public Health Systems • Sec. 4003. Clinical and Community Preventive Services. • Provides more detailed statutory guidance for the creation and role of • Preventive Services Task Force • reviews scientific evidence related to efficacy of clinical preventive services • develops and updates recommendations for the health care community • published in the Guide to Clinical Preventive Services. • Community Preventive Services Task Force • Develops community preventive interventions recommendations • Published in The Guide to Community Preventive Services • individuals and organizations delivering population-based services. • Task forces • submit yearly reports to Congress and related agencies • identifying gaps in research and recommending priority areas

  8. Subtitle A- Modernizing Disease Prevention and Public Health Systems • Sec. 4004. Education and outreach campaign regarding preventive benefits. • National science-basedmedia campaign on health promotion and disease prevention. • Raise public awareness of health improvement across the life span. • Mandates an Internet website • To provide science-based information to health care providers and consumers • On guidelines for nutrition, regular exercise, obesity reduction, smoking cessation, and specific chronic disease prevention. • Mandates a Federal Internet website personalized prevention plan tool • allows individuals to determine their disease risk relating to the 5 leading diseases • obtain personalized suggestions for preventing such diseases • Mandates Internet portal for accessing risk-assessment tools • developed and maintained by private and academic entities. • $500 Million in funding available • Provide guidance and relevant information to States and health care providers • regarding preventive and obesity-related services available to Medicaid enrollees, • All States - design a public awareness campaign • to educate Medicaid enrollees regarding the availability and coverage of such services, and • report to Congress on the status and effectiveness of these efforts no later than 1/1/2011.

  9. Subtitle B - Increasing Access to Clinical Preventive Services • SEC. 4101: School-Based Health Centers • Provides grants for the establishment of School-Based Health Centers • Preference is awarded to large population of children eligible for medical assistance or a wavier under State Medicaid plan • Limitations: • Used for: • Acquisition or improvement of land • Construction, expansion, replacement or other improvements of any building • Equipment • Not Used for • Personnel • Provide Health services • $50,000,000 appropriated for FY 10-13

  10. Subtitle B - Increasing Access to Clinical Preventive Services • SEC. 4102: Oral Healthcare Prevention Activities • Adds Oral Healthcare Prevention Education Campaign • Establish a 5-year national, public education campaign • Focuses on oral healthcare prevention & education • Prevention of oral diseases • Utilizes science-based strategies to convey oral health prevention messages • Adds Research-Based Dental Caries Disease Management • Anyone that is involved in improving children’s oral health • Funds used to demonstrate the effectiveness of research-based dental caries disease management activities • Appropriation Expanded from 16 states to all 50 states, territories, and D.C

  11. Subtitle B - Increasing Access to Clinical Preventive Services • SEC. 4103: Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan • Personalized Prevention Plan = the creation of a plan for an individual • Includes: • Health Risk Assessment • Establishment or update of medical and family history • List of Providers and Suppliers that are regularly involved in providing medical care • Ht, Wt, BMI, BP and other routine measurements • Detection of any cognitive impairment • List of risk factors w/ prevention interventions • Furnishing of personalized health advice and a referral • A beneficiary shall only be eligible to receive an initial preventive physical examination at any time during the 12-month period after the date that the beneficiary's coverage begins under part B and shall be eligible to receive personalized prevention plan services under this subsection provided that the beneficiary has not received such services within the preceding 12-month period. • Payment to the provider will be 100% of the physician fee schedule amount

  12. Subtitle B - Increasing Access to Clinical Preventive Services • SEC 4104: Removal of Barriers to Preventive Services in Medicare • Eliminates cost sharing requirement for Medicare covered preventive services (Rated A or B) • Waives deductible for preventive services and Colorectal Cancer Screening • Effective Date 1 January 2011

  13. Subtitle B - Increasing Access to Clinical Preventive Services • SEC 4105: Evidence-Based Coverage of Preventive Services in Medicare • Authorizes the Secretary to modify or eliminate coverage of certain preventive services • Effective 1 January 2010

  14. Subtitle B - Increasing Access to Clinical Preventive Services • SEC 4106: Improving Access to Preventive Services for Eligible Adults in Medicaid • States providing Medicaid coverage must include clinical preventive services assigned a grade of A or B and Adult immunizations • States providing services and vaccines without any beneficiary cost; receive the applicable Fmap plus 1% point for these services • Also includes tobacco cessation for pregnant women (SEC 4107) • Effective 1 January 2013

  15. Subtitle B - Increasing Access to Clinical Preventive Services • SEC 4107: Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid • States fund counseling and pharmacotherapy • No cost sharing • Services included: • Diagnostic • Therapy • Counseling • Pharmacotherapy (Prescription and Nonprescription) • Effective 1 October 2010

  16. Subtitle B - Increasing Access to Clinical Preventive Services • SEC 4108: Incentives for Prevention of Chronic Diseases in Medicaid • Purpose: Test approaches that may encourage behavior modification and determine scalable solutions • Make grants available to states for healthy lifestyle programs • Successfully participate in a program • Upon completion must demonstrate changes in health risk and outcomes, to include adoption and maintenance of healthy behaviors by meeting targets • Programs base on relevant evidence-based research • Programs must be carried out by a State for 3 or more years • Programs include: Ceasing use of tobacco products, Controlling or reducing their weight, Lowering their cholesterol, Lowering their blood pressure, Avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition, or Co-morbidities

  17. Subtitle B - Increasing Access to Clinical Preventive Services • SEC 4108: Incentives for Prevention of Chronic Diseases in Medicaid (cont.) • Education and Outreach Campaign • Grant for state awareness • Grant for Medicaid beneficiaries and providers participating in Medicaid who reside in the State aware of the programs described • A state awarded a grant must: • Track Medicaid beneficiary participation in programs and validate changes in health risk and outcomes • Establish standards and health status targets • Evaluate Effectiveness of program • Report findings • Findings are submitted semi-annually • 1 January 2014 Secretary shall submit initial report to Congress • NLT 1 January 2016 Secretary shall submit final report to Congress • 5-year period beginning on 1 January 2011 w/ finding of $100,000,000

  18. Subtitle C-Creating Healthier Communities • Sec. 4201. Community Transformation Grants • Healthier school environments (phys. ed., food, wellness, activity) • Infrastructure to support healthy living • Tobacco use, mental health, weight, nutrition • Worksite wellness • Highlight healthy restaurant options • Strategies to reduce disparities: • Racial • Ethnic • Social • Economic • Geographic • Special populations needs, disabilities, urban and rural areas

  19. Subtitle C - Creating Healthier Communities • Sec. 4202. Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries • 5 year pilot programs for public health interventions, screenings, clinical referrals for individuals (55-64) • State health department, local health department, Indian tribes • Public Health Intervention programs • Government contracts with community health centers • Screenings for: • Cardiovascular disease, cancer, stroke, diabetes • $50,000,000 in funding from Federal Hospital Insurance Trust Fund of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplemental Medical Insurance Trust to the Centers for Medicare & Medicaid Services Program Management Account

  20. Subtitle C - Creating Healthier Communities • Sec. 4203. Removing barriers and improving access to wellness for individuals with disabilities • Amends Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et seq.): • SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MEDICAL DIAGNOSTIC EQUIPMENT • 24 months after enactment, establishes the minimum technical criteria for medical diagnostic equipment used in (or in conjunction with) physician's offices, clinics, emergency rooms, hospitals, and other medical settings. • Equipment includes: examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals.

  21. Subtitle C - Creating Healthier Communities • Sec. 4204. Immunizations • Grants to States to improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based, population-based interventions for high-risk populations • Providing immunization reminders or recalls for target populations of clients, patients, and consumers; • Educating targeted populations; • Reducing out-of-pocket costs for families for vaccines and their administration; • Carrying out immunization-promoting strategies • Home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; • Reminders or recalls for immunization providers; • Conducting assessments of, and providing feedback to, immunization providers; • Combination of one or more interventions described in this paragraph; or • Immunization information systems for electronic databases and immunization records. • Medicare Part D

  22. Subtitle C - Creating Healthier Communities • Sec. 4205. Nutrition labeling of standard menu items at chain restaurants • A restaurant chain of 20 or more locations: • The calories and nutritional content for each item and place this information on the menu • The same information on boards used for drive-through ordering • The same information for any items on a buffet or cafeteria line • Not required for: condiments, <60 days, custom orders • Vending machines >20 machines

  23. Subtitle C - Creating Healthier Communities • Sec. 4206. Demonstration project concerning individualized wellness plan • Amends Section 330 of the Public Health Service Act (42 U.S.C. 245b) is amended by adding at the end the following • An individualized wellness plan prepared under the pilot program under this subsection may include one or more of the following as appropriate to the individual's identified risk factors: (i) Nutritional counseling. • A physical activity plan. • Alcohol and smoking cessation counseling and services. • Stress management. • Dietary supplements that have health claims approved by the Secretary. • Compliance assistance provided by a community health center employee. • Risk Factors- Wellness plan risk factors shall include-- (i) weight; • tobacco and alcohol use; • exercise rates; • nutritional status; and • blood pressure. • Comparison between individualized wellness plans and control group

  24. Subtitle C - Creating Healthier Communities • Sec. 4207. Reasonable break time for nursing mothers • Reasonable time for employee to express breast milk for 1 year after the child’s birth • Location, other than bathroom, shielded from view and free from intrusion • Required compensation during reasonable break time • Not required for companies with <50 employees • Undue hardshipbecause of employers business: • Size • Financial resources, • Nature • Structure

  25. Subtitle D - Support for Prevention and Public Health Innovation • Sec. 4301. Research on optimizing the delivery of public health services • Examine Evidence-based practices for Healthy People 2020 • Interventions from academic settings to real world setting • Effective strategies for organizing, financing and delivering public health services • Sec. 4302. Understanding health disparities: data collection and analysis • Data Collection, Analysis, and quality • Address Health Care Disparities • Protecting Patient Privacy • Minimize Administrative burdens

  26. Subtitle D - Support for Prevention and Public Health Innovation • Sec. 4303. CDC and employer-based wellness programs • Technical assistance for employer-based wellness programs. • National worksite health policies and programs study • Prioritization of evaluation by secretary • Prohibition of federal workplace wellness requirements • Sec. 4304. Epidemiology-Laboratory Capacity Grants • Strengthening epidemiologic capacity to identify and monitor the occurrence of infectious diseases and other conditions of public health importance; • Enhancing laboratory practice as well as systems to report test orders and results electronically; • Improving information systems • Developing and implementing prevention and control strategies

  27. Subtitle D - Support for Prevention and Public Health Innovation • Sec. 4305. Advancing research and treatment for pain care management. • Secretary (DHHS) establish agenda on pain • to improve the state of pain care research, education, and clinical care • reduce barriers to appropriate pain care and significantly • Convene Conference on Pain in concert with the Institute of Medicine • Report to Congress Conference’s findings and recommendations. • Director of NIH through the Pain Consortium, • basic and clinical research program on causes of and potential treatments for pain. • Annual recommendations on pain research initiatives • Mandates - Interagency Pain Research Committee • to coordinate all pain research efforts within HHS and other Federal agencies • Authorizes grants, cooperative agreements, and contracts • to health professions schools, hospices, and other public and private entities • for education and training programs

  28. Subtitle D - Support for Prevention and Public Health Innovation • Sec. 4306. Funding for Childhood Obesity Demonstration Project. • Appropriates $25 million for the period of FYs 2010-2014 for the Childhood Obesity • Demonstration Project originally mandated under the Children’s Health Insurance • Program Reauthorization Act of 2009. This replaces a current authorization of $25 • million for the period of FYs 2009-2013.

  29. Subtitle E - MISCELLANEOUS PROVISIONS • SEC. 4401: Sense of the Senate Concerning CBO Scoring • Findings: Costs of prevention programs are difficult to estimate because prevention initiatives are hard to measure and results may occur outside the 5 and 10 year budget windows • Sense of Congress: Congress should work with CBO to develop better methodologies for scoring progress

  30. Subtitle E - MISCELLANEOUS PROVISIONS • SEC. 4402: Effectiveness of Federal Health & Wellness Initiatives • Secretary of Health and Human Services shall: • conduct an evaluation of such programs (including absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees, and health conditions, including workplace fitness, healthy food and beverages, and incentives in the Federal Employee Health Benefits Program) • Submit to Congress a report • conclusions concerning the reasons that such existing programs • have proven successful or not successful • what factors contributed to such conclusions

  31. Conclusion • Overview of Title IV • Purpose • Contents • Amendments to other legislation • Subtitles • A – Modernizing Disease Prevention and Public Health Systems • B – Increasing Access to Clinical Preventive Services • C – Creating Healthier Communities • D – Support for Prevention and Public Health Innovation • E – Miscellaneous Provisions

  32. References • http://www.nytimes.com/interactive/2014/05/19/health/rating-a-health-laws-success.html?_r=0 • http://www.brookings.edu/research/papers/2013/10/affordable-care-act-user-guide-to-implementation-burke-kamarck • http://www.hks.harvard.edu/index.php/news-events/news/articles/measuring-the-effectiveness-of-the-affordable-care-act • http://www.medicaid.gov/affordablecareact/provisions/prevention.html • http://www.hhs.gov/healthcare/rights/law/index.html • 2014 Report to Congress on Preventive Services and Obesity-related Services Available to Medicaid Enrollees http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/downloads/rtc-preventive-obesity-related-services2014.pdf • U.S. Preventive Services Task Force - Annual Reports http://www.uspreventiveservicestaskforce.org/Page/Name/reports-to-congress • http://www.hhs.gov/healthcare/rights/law/index.html • http://www.forbes.com/sites/carolynmcclanahan/2012/07/09/cliffs-notes-version-of-the-affordable-care-act/ • The Community Guide to Preventative Services: Community Preventive Services Task Force FIRST ANNUAL REPORT TO CONGRESS (2011) AND TO AGENCIES RELATED TO THE WORK OF THE TASK FORCE http://www.thecommunityguide.org/annualreport/2011-congress-report-exec.pdf • http://en.wikisource.org/wiki/Patient_Protection_and_Affordable_Care_Act/Title_IV#TITLE_XXXI--DATA_COLLECTION.2C_ANALYSIS.2C_AND_QUALITY • http://www.whitehouse.gov/health-care-meeting/proposal/titleiv/smallbusiness

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