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Healthcare Reform Timeline

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Healthcare Reform Timeline

January 1, 2013

Health Care Exchanges
State Notification Regarding Exchanges States indicate to the Secretary of HHS whether they will operate an American Health Benefit Exchange.

Closing Medicare Drug GAP
Closing the Medicare Drug Coverage Gap Begins phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

Bundled Payment Pilots
Medicare Bundled Payment Pilot Program Establishes a national Medicare pilot program to develop and evaluate making bundled payments for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

Medicaid Coverage of Preventive Services
Medicaid Coverage of Preventive Services Provides a one percentage point increase in federal matching payments for preventive services in Medicaid for states that offer Medicaid coverage with no patient cost sharing for services recommended (rated A or B) by the U.S. Preventive Services Task Force and recommended immunizations.

Itemized Deductions for Medical Expenses
Itemized Deductions for Medical Expenses Increases the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.

Flexible Spending Acct Limited
Flexible Spending Account Limits the amount of contributions to a flexible spending account for medical expenses to $2,500 per year, increased annually by the cost of living adjustment.

Increase in Medicare Taxes
Medicare Tax Increase Increases the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and imposes a 3.8% assessment on unearned income for higher-income taxpayers.

Limit on Medicare Part D coverage for Retirees
Employer Retiree Coverage Subsidy Eliminates the tax-deduction for employers who receive Medicare Part D retiree drug subsidy payments.

Medical Device Tax
Tax on Medical Devices Imposes an excise tax of 2.3% on the sale of any taxable medical device.

Medicaid Payment for Primary Care
January 1, 2013 through December 31. 2014
Medicaid Payments for Primary Care Increases Medicaid payments for primary care services provided by primary care doctors to 100% of the Medicare payment rate for 2013 and 2014 (financed with 100% federal funding).

Financial Disclosure
Report to Congress due April 1, 2013

Financial Disclosure Requires disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biological, and medical supplies.

CO-OP Health Plans
CO-OPs established by July 1, 2013

CO-OP Health Insurance Plans Creates the Consumer Operated and Oriented Plan (CO-OP) to foster the creation of non-profit, member-run health insurance companies.

Child Health Insurance
Fiscal year 2013
Extension of CHIP Extends authorization and funding for the Children’s Health Insurance Program (CHIP) through 2015 (current authorization is through 2013).

October 1, 2013

Medicare DSH Reductions
Medicare Disproportionate Share Hospital Payments Reduces Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increases payments based on the percent of the population uninsured and the amount of uncompensated care provided.

Medicare DSH Reductions
Medicaid Disproportionate Share Hospital Payments Reduces states’ Medicaid Disproportionate Share Hospital (DSH) allotments and requires the Secretary to develop a methodology for distributing the DSH reductions.


January 1, 2014

Medicaid Expansion
Expanded Medicaid Coverage Expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL and provides enhanced federal matching payments for new eligibles. Presumptive Eligibility for Medicaid Allows all hospitals participating in Medicaid to make presumptive eligibility determinations for all Medicaid-eligible populations.

Required Health Insurance
Individual Requirement to Have Insurance Requires U.S. citizens and legal residents to have qualifying health coverage (there is a phased-in tax penalty for those without coverage, with certain exemptions).

Premium Subsidies for 133-400%
Health Insurance Premium and Cost Sharing Subsidies Provides refundable and advanceable tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the Exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.

Guaranteed Availability of Insurance
Guaranteed Availability of Insurance Requires guarantee issue and renewability of health insurance regardless of health status and allows rating variation based only on age (limited to a 3 to 1 ratio), geographic area, family composition, and tobacco use (limited to 1.5. to 1 ratio) in the individual and the small group market and the Exchanges.

No Annual Limits
No Annual Limits on Coverage Prohibits annual limits on the dollar value of coverage.

Essential Health benefits package
Essential Health Benefits Creates an essential health benefits package that provides a comprehensive set of services, limiting annual cost-sharing to the Health Savings Account limits ($5,950/individual and $11,900/family in 2010). Creates four categories of plans to be offered through the Exchanges, and in the individual and small group markets, varying based on the proportion of plan benefits they cover.

Multi-State Health Plans
Multi-State Health Plans Requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

Basic Health Plan option for 133-200%
Basic Health Plan Permits states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.

Employer Penalty for Non-Coverage
Employer Requirements Assesses a fee of $2,000 per full-time employee, excluding the first 30 employees, on employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with more than 50 employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees.

Medical Loss Ratio set at 85%
Medicare Advantage Plan Loss Ratios Requires Medicare Advantage plans to have medical loss ratios no lower than 85%.

Wellness Programs
Wellness Programs in Insurance Permits employers to offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in a wellness program and meeting certain health-related standards; establishes 10-state pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

Health Insurance Fees
Fees on Health Insurance Sector Imposes new fees on the health insurance sector.


Temporary Reinsurance
January 1, 2014 through December 31, 2016

Temporary Reinsurance Program for Health Plans Creates a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals.

Hospital Acquired Conditions Penalty
Implementation 2015

Reduces Medicare payments to certain hospitals for hospital-acquired conditions by 1%

Increase in CHIP Match %
October 1, 2015
Increase Federal Match for CHIP Provides for a 23 percentage point increase in the Children’s Health Insurance Program (CHIP) match rate up to a cap of 100%.

Multi State Compacts
January 1, 2016
Health Care Choice Compacts Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact.

Tax on High-Cost Insurance
January 1, 2018

Tax on High-Cost Insurance Imposes an excise tax on insurers of employer-sponsored health plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.