Ffg Legislative Update Healthcare Reform Summary

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Ffg Legislative Update Healthcare Reform Summary

  1. 1. Forest Financial Group Legislative Update March 23, 2010 Legislative Update Forest Financial Group is pleased to offer updates focusing on legislation changes and decisions that impact our clients. It is important to us that our >>Company Logo<< clients are kept abreast of changes in both Washington and Springfield that apply to employee benefits. FFG aims to provide you with a better understanding of our healthcare system, our federal and statutory laws, and our industry regulations. We hope you find this information valuable to the administration of your benefits program. Healthcare Reform Summary March 23, 2010 President Signs Sweeping Healthcare Reform On Tuesday, March 23, 2010 the President signed health reform legislation passed by the U.S. House of Representatives and the Senate, taking a critical step toward the enactment of comprehensive health reform. The Senate health reform bill, H.R. 3590, the "Patient Protection and Affordable Care Act," passed by a vote of 219 to 212, with all Republicans and 34 Democrats voting against it. The House also passed H.R. 4872, the "Reconciliation Act of 2010," on a Legislative Update vote of 220-211, with all Republicans and 33 Democrats voting against the bill. The Senate is expected to take up the reconciliation bill this week. Highlights of some Key Provisions of the Senate Bill as amended by the Reconciliation Bill include: Keeping You Informed Insurance Exchanges – Beginning in 2014, creates state-based Exchanges and Co- ops to provide insurance in the individual and small business markets. There is no public option. Individual Mandate – Beginning in 2014, individuals are required to have health insurance and will be subject to a penalty (fined), if they are not enrolled. Individuals below the threshold for filing federal income tax will be exempt. Federal subsidies are provided to individuals that: 1) do not qualify for Medicaid, and 2) have incomes below 400% of the Federal Poverty Level. Employer Mandate – Beginning in 2014, employers with more than 50 full-time employees (including full and part-time ) must either: 1) Offer health insurance coverage , and will be subject to penalties if any employee(s) receive subsidized coverage through the Exchange, or 2) Not offer coverage and pay financial penalties based on the number of full- time employees. Private Insurance Market Reforms – Immediately prohibits or restricts private insurers from rescinding policies, setting lifetime or annual limits, setting excessive waiting periods, and requires plans to cover dependents up to age 26. Additional requirements starting in 2014 include: the elimination of pre-existing conditions exclusions, implementation of modified community rating and guaranteed issue, and the institution of minimum benefit requirements to ensure that plans are adequate. Forest Financial Group Legislative Update March 23, 2010
  2. 2. Forest Financial Group Taxes and Industry Fees – In order to raise revenues to cover the costs of Legislative Update expanding healthcare to all and to provide subsidies for individuals to purchase private insurance, the bill expands the Medicare payroll tax for individuals earning more than March 23, 2010 $200,000 annually and couples earning more than $250,000; and, as of 2018, establishes an excise tax on high-valued insurance plans. In addition, several industries – including pharmaceutical manufacturers, medical device manufacturers, >>Company Logo<< and health plans – will be subject to additional fees/taxes. Medicaid Expansions and Reforms –Beginning in 2014, requires states to cover individuals with incomes up to 133% of the Federal Poverty Level and provides for 100% federal funding of this expansion. Increases rebates for brand drugs and expands rebates for drugs provided by managed care organizations. Medicare Reforms ● Medicare Advantage – Beginning in 2011 and phased in over three years, reduces payments to Medicare Advantage plans bringing them more in line with fee-for-service payments. ● Medicare Part D Prescription Drug Discounts – Beginning in 2011, requires drug manufacturers to contribute 50% discounts to beneficiaries while in the donut hole coverage gap. ● Payments to Hospitals and other Facilities – Reduces the annual update in fees for hospitals, skilled nursing facilities, long-term care and rehab Legislative Update facilities, hospices, and home health. Reduces disproportionate-share payments to hospitals. ● Delivery Reforms – Creates a CMS Innovation Center to fund demonstration projects, creates Accountable Care Organizations and other shared savings programs, provides state grants for community-based delivery systems such Keeping You Informed as patient-centered medical homes, and creates an independent advisory board which will recommend changes to limit spending under federal insurance programs. ● Imaging Payment Reductions – Reduces payments for MRI and CTS diagnostic tests. ● Physician-owned Hospitals- Prohibits the establishment of such hospitals as of December 31, 2010. Prevention and Wellness – Beginning in 2014, provides coverage of annual wellness visits, waives co-insurance, and allows Secretary of HHS to expand coverage of preventive services covered by Medicare and Medicaid. Provides funding to state and local health departments as well as funds for research and numerous prevention and wellness oriented programs. Comparative Effectiveness Research - Creates an independent corporation to set priorities and assess comparative effectiveness research funded by NIH and AHRQ. The subjects covered above are for your summary reference. As more information is released and determined about health care reform activities, Forest Financial Group will be disseminating additional guidelines for your review. At any time, should you have questions about health care reform or any other benefit related subject, please contact our office. As our valued client, it is our privilege to be of service. Forest Financial Group Legislative Update March 23, 2010

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