The Patient Protection and Affordable Care Act (PPACA) And The Health Care and Education Reconciliation Act

1. HEALTH REFORM and VACCINES: Review of Federal Legislation The Patient Protection and Affordable Care Act (PPACA)AndThe Health Care and Education Reconciliation Act Alexandra Stewart June 2, 2010

2. Presentation Outline Topics • Employer Plans • Medicaid • Medicare • Quality and innovation • Population Health and Prevention Initiatives • Research • School-based Health Centers • Funding for Vaccine Programs • Workforce Issues

3. Employer Plans Small Employer plans = 1-100 employees (may be limited to 50 employees before 2016) Large employer plan = 100+ employees Source: Title I – Quality, Affordable Health Care for All Americans; Subtitle D – Available Coverage for All Americans; Sec. 1304. Related Definitions

8. Public Funding: Medicaid New Mandatory Categories New Optional Categories Legal Immigrants New Prevention Benefits – Optional Adult Vaccine Coverage Physician Reimbursement

12. Medicare: Coverage Reimbursement Research and Outreach

14. Medicare – Wellness and Personalized Prevention • ANNUAL WELLNESS VISIT • COMPREHENSIVE HEALTH RISK ASSESSMENT • PERSONALIZED PREVENTION PLAN • A 5 to 10-year screening schedule • A list of identified risk factors and conditions and a strategy to address them • Health advice and referral to education and preventive counseling or community-based interventions to address modifiable risk factors such as physical activity, smoking, and nutrition • Beneficiaries are eligible for the initial preventive physical exam in their first year of coverage and for personalized prevention services annually thereafter. Source: TITLE IV - PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH ; Subtitle B – Increasing Access to Clinical Preventive Services; Sec. 4103. Medicare coverage of annual wellness visit providing a personalized prevention plan. Sec. 4104. Removal of barriers to preventive services in Medicare; Sec. 4105. Evidence-based coverage of preventive services in Medicare.; Sec. 10406

18. Healthcare Quality and Innovation: Improve health outcomes Coordinate care Prevent hospital readmissions Improve patient safety Promote wellness and health

19. Ensuring Quality Care – Private Insurers The Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for insurers to report on their initiatives and programs that: • Improve health outcomes by using care coordination and chronic disease management • Prevent hospital readmissions and improve patient safety, and • Promote wellness and health. Source: Title I – Quality, Affordable Health Care for All Americans; Subtitle A – Immediate Improvements in Health Care Coverage for All Americans; Sec. 2717. Ensuring quality of care.

20. Population Health & Prevention Initiatives Investments in Public Health Outreach and Education

22. Population Health and Prevention Strategy EVALUATION ACTIVITY The Secretary shall evaluate the effectiveness of existing Federal health and wellness initiatives and report to Congress whether the programs have been effective in achieving their stated goals and evaluate their effect on the health and productivity of the Federal workforce DEMONSTRATION PROGRAM The Secretaries of HHS and the CDC may award grants to states to improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based and population-based interventions. Source: Title IV – Prevention of Chronic Disease and Improving Public Health; Subtitle E – Miscellaneous Provisions, Sec. 4402 Effectiveness of Federal health and wellness initiatives. Title IV – Prevention of Chronic Disease and Improving Public Health; Subtitle C – Creating Healthier Communities; Sec. 4204. Immunizations.

23. Research: Funding and Reporting The Secretary of Health and Human Services, through the Director of CDC, shall provide funding for research in the area of public health services and systems that will: • Examine evidence-based practices relating to prevention, with a particular focus on high priority areas as identified in the National Prevention Strategy or Health People 2020 • Analyze the translation of interventions from academic settings to real world settings, and • Identify effective strategies for organizing, financing, or delivering public health services in real world community settings. Research supported under this section shall be coordinated with the Community Preventive Services Task Force and carried out with existing Federal, state, local, and private partnerships and initiatives. • The Secretary shall report findings to Congress annually Source: Sec. 4301. Research on optimizing the delivery of public health services.

24. School-based Health Centers

26. Funding for Vaccine Programs

28. Workforce Reimbursement, TrainingandReadiness

30. Summary Review of Federal Health Reform Legislation • The Patient Protection and Affordable Care Act (PPACA) • The Health Care and Education Reconciliation Act Topics • Employer Plans • Medicaid • Medicare • Quality and innovation • Population Health and Prevention Initiatives • Research • School-based Health Centers • Funding for Vaccine Programs • Workforce Issues