Patient Protection Affordable Care Act (PPAC) Timelines for Implementation

Now that the Patient Protection and Affordable Care Act (PPAC) is law, there are some important dates and timelines for how this sweeping new health care reform will be implemented.   Of course these are deadlines, and it is up to the Federal Government to implement.  

According to a recently released Rutgers study by Stuart Shapiro, the mean time for completing a regulation from start to finish is 831 days  or about two and a third years.  This being a piece of immensely complicated legislation (3000+ pages with the reconciliation package) we anticipate that this time frame may be even longer

Below are some of the important provisions and when they will take effect:

Medicare Physician Payment 

Congress will address the sustainable growth rate formula in separate legislation this summer. Currently, physician payments are frozen at 2009 levels through March 31.

Primary Care Bonus Payments

Beginning in 2011 and effective until 2016, all primary care physicians will be eligible for a 10% bonus in Medicare payments. To qualify, at least 60% of the physicians total Medicare charges must be comprised of office, nursing home, and home care visits.

General Surgery Bonus Payments

Beginning in 2011 and effective until 2016, general surgeons who perform major procedures in a health professional shortage area will be eligible for a 10% bonus payment for those services. Major procedure is defined as any service with a 10 or 90 day global payment.

Medicaid Payments

From 2013 through 2014, Medicaid payments will be raised for evaluation and management (E&M) services to at least 100% of Medicare payment rates.

Geographic Payment Adjustments

Effective this year, the legislation establishes the “floor” on the work geographic practice cost indice (GPCI) at 1.0 for all localities for 2010. Medicare will begin making a separate adjustment for the practice expense portion of physician payments in 2010 and 2011. This provision also increases the practice expense GPCI adjustment for physicians in North Dakota, Montana, South Dakota, Utah and Wyoming to the national average beginning in 2011.

Medical Liability Reform

In 2011, the Secretary of Health and Human Services (HHS) is authorized to award five-year demonstration grants to states to develop, implement and evaluate alternative medical liability reform initiatives, such as health courts and early offer programs. Medical liability protections under the Federal Tort Claims Act (FTCA) are extended to officers, governing board members, employees, and contractors of free health clinics.

Community Health Centers

Funding for Community Health Centers increases by $11 billion in 2011, to assist in providing care to uninsured and underinsured individuals.

Prevention and Wellness

This year, Medicaid will be required to cover tobacco cessation services for pregnant women. Cost-sharing for preventive services is eliminated in Medicare and Medicaid programs beginning in 2011. Medicare payments for these preventive services will be increased to 100 percent of payment schedule rates. Health plans are required to provide a minimum level of coverage without cost-sharing for preventive services beginning in 2010.

Mental Health Incentive Payments

This year, Medicare will increase payments for psychotherapy services by 5%.

Administrative Simplification

From 2013 through 2016 national rules will be implemented to standardize and streamline health insurance claims processing requirements.

 Insurance Reforms

Beginning this year, almost immediately, insurers are prohibited from denying coverage to children who have pre-existing conditions. Insurers are prohibited from placing lifetime limits on how much they pay out to individual policyholders and from rescinding coverage except in the case of fraud. Adult dependent children up to the age of 26 are eligible for coverage under their parents or legal guardians’ insurance policies.

Medicare Prescription Drug Coverage

Also beginning this year, Medicare beneficiaries whose prescription expenses reach the so-called Medicare Part D coverage "doughnut hole" ($2,700 to $6,150) in 2010 will receive a $250 rebate. In 2011, the provision institutes a 50 percent discount on brand-name drugs and begins generic coverage in the donut hold; fills the donut hole by 2020.

Coverage Mandates – Employers

Beginning in 2014, employers with more than 50 employees, with a minimum of one full-time employee, which receives a premium tax credit, are required to offer health insurance coverage to their employees or face penalties. Employers with 50 employees or less are exempt from this requirement.

Coverage Mandate – Individuals

Also starting in 2014, individuals are required to either purchase health care coverage or demonstrate coverage through their employer or other program or face penalties.

Medicaid Expansion

In 2014, low-income individuals under the age of 65 and at or below 133% of the federal poverty level ($29,327 for family of four) are eligible for Medicaid coverage.

2010

Effective 90 days after the bill was enacted, eligible individuals will have access to coverage that does not impose any coverage exclusions for pre-existing health conditions. The provision ends when Insurance Exchanges are operational.

Small businesses’ will receive a credit up to 35 percent of the employers’ contribution to provide health insurance for employees. There is also up to a 25 percent credit for small nonprofit organizations. When the Exchanges are operational, tax credits will be up to 50 percent of premiums.

Effective six months after enactment and applying to all employer plans and new plans in the individual market, insurance companies cannot impose pre-existing condition exclusions on children’s coverage. Also effective in this time period:

– Health insurances companies are prevented from rescinding existing health policies when a person gets sick;

– Insurers are prohibited from imposing lifetime limits on benefits;

– New group health plans and plans in the individual market must provide first dollar coverage for preventive services; and

– Extends coverage until children turn 26 years of age;

During the calendar year 2010, the legislation extends Medicare payment protections for small rural hospitals, including hospital outpatient services, lab services, and facilities that have a low-volume of Medicare patients.

The bill also invests in new therapies with a two-year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose and treat acute and chronic diseases.

Enacts fully funded practice expense Geographic Practice Cost Index floor increase in 2010 and 2011 for physicians and therapists.

The bill establishes a private, non-profit institute to identify national priorities and provide for research to compare the effectiveness of health treatments and strategies.

Creates a national commission to provide comprehensive, nonbiased information and recommendations to Congress and the Administration for aligning federal health care workforce resources with national needs.  

Establishes a Patient-Centered Outcomes Research Institute to contract with appropriate federal agencies or the private sector to conduct comparative effectiveness research (CER).

The bill also increases support for primary care by establishing a Graduate Medical Education policy allowing unused training slots to be re-distributed for purposes of increasing primary care training at other sites, and also expanding the size of the primary care nursing workforce in July, 2011.

Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on W-2 forms, effective for tax years beginning after December 31, 2010.

Pharmaceutical companies are imposed with an annual, non-deductible fee according to market share. This fee does not apply to companies with sales of branded pharmaceuticals of $5 million or less.

Time Line Resources:

For more information see

Kaiser Foundation Summary of Health Reform Law

Kaiser Foundation Time Line of Health Reform Law

Speaker’ Office Implementation Timeline.

House Energy and Commerce Committee Timeline 3-18-10