Hospital Health Care Reform Provisions


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Listing of health care reform (Obamacare) provisions that effect hospitals and their administration.

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Hospital Health Care Reform Provisions

  1. 1. Hospital Healthcare Reform Provisions
  2. 2. Section 1001 Subsection 2713: Preventive Healthcare CoverageA group health plan and a health insurance issuer offering group or individualhealth insurance coverage shall provide preventive care and screenings toinfants, children, adolescents and young adults.
  3. 3. Section 1201: Prohibition of Preexisting ConditionsA group health plan and a health insurance issuer offering group or individualhealth insurance coverage may not impose any preexisting condition exclusionwith respect to such plan or coverage.
  4. 4. Section 2301: Coverage for Birthing CentersA State shall provide separate payments to providers administering prenatallabor and delivery or postpartum care in a freestanding birth center(as defined in subparagraph (B)), such as nurse midwives and otherproviders of services such as birth attendants recognized under State law, asdetermined appropriate by the Secretary. Nothing in this subparagraphshall be construed as changing State law requirementsapplicable to a birth attendant.
  5. 5. Section 3008: Incentive to Reduce Hospital Acquired ConditionsIn order to provide an incentive for applicable hospitals to reduce hospital acquiredconditions with respect to discharges occurring during fiscal year 2015, the amountof payment shall be equal to 99% of the amount of payment that would otherwiseapply to such discharges.
  6. 6. Section 3025: Payment Reduction for Hospital ReadmissionsDischarges occurring on or after October 1, 2012, in order to account for excessreadmissions, the Secretary shall reduce payments for such discharge by anamount equal to the product of the base operating DRG payment amountfor the discharge; and the adjustment factor for the hospital for the fiscal year.
  7. 7. Section 3111: Payment for Bone Density TestsFor dual-energy x-ray absorptiometry services (bone density, identified in 2006by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during2010 and 2011, instead of the payment amount that would otherwise bedetermined under this section for such years, the payment amount shall beequal to 70 percent of the product.
  8. 8. Section 3125: Payment for Low-Volume HospitalsFor discharges occurring in fiscal years 2011 and 2012, the Secretary shalldetermine an applicable percentage increase for purposes of using a continuous’linear sliding scale ranging from 25 percent for low-volume hospitals with 200 orfewer discharges of individuals entitled to, or enrolled for, benefits under part Ain the fiscal year to 0 percent for low-volume hospitals with greater than 1,500discharges of such individuals in the fiscal year.
  9. 9. Section 3133: Disproportionate Share Hospital PaymentsFor fiscal year 2015 and each subsequent fiscal year, instead of the amount ofdisproportionate share hospital payment that would otherwise be made to ahospital for the fiscal year, the Secretary shall pay to the hospital a 25 percent ofsuch amount (which represents the empirically justified amount for such payment,as determined by the Medicare Payment Advisory Commission in its March 2007Report to the Congress).
  10. 10. Section 3134: Misvalued Codes Under Physician Fee ScheduleFor purposes of identifying potentially misvalued services, the Secretary shallexamine (as the Secretary determines to be appropriate) codes (and families ofcodes as appropriate) for which there has been the fastest growth; codes(and families of codes as appropriate) that have experienced substantialchanges in practice expenses; codes for new technologies or services within anappropriate period (such as 3 years) after the relative values are initiallyestablished for such codes.
  11. 11. Section 4104: Elimination of Co-PayElimination of coinsurance (co-pay) on preventive services (i.e. physical exams)in outpatient hospital settings.
  12. 12. Section 4108: Incentive for Prevention of Chronic DiseasesIncentives for prevention of chronic diseases. A program described in thisparagraph is a comprehensive, evidence-based, widely available, and easilyaccessible program, proposed by the State and approved by the Secretary,that is designed and uniquely suited to address the needs of Medicaidbeneficiaries and has demonstrated success in helping individuals achieveone or more of the following: ceasing use of tobacco products, controlling orreducing their weight, lowering their cholesterol, lowering their blood pressure,avoiding the onset of diabetes or, in the case of a diabetic, improving themanagement of that condition.
  13. 13. Section 9007: Taxes on Hospital FailuresIf a hospital organization to which section 501(r) applies fails to meet therequirement of section 501(r)(3) for any taxable year, there is imposed onthe organization a tax equal to $50,000.The Secretary of the Treasury or theSecretarys delegate shall review at least once every 3 years the communitybenefit activities of each hospital organization to which section 501(r) of theInternal Revenue Code of 1986 applies.
  14. 14. Section 9017: Excise Tax on Cosmetic SurgeryThere is hereby imposed on any cosmetic surgery and medical procedure a taxequal to 5 percent of the amount paid for such procedure (determined withoutregard to this section), whether paid by insurance or otherwise.
  15. 15. For More Information Visit