New health care law provisions that kicked in January 1

[ProSense]

Via Kaiser

Minimum Medical Loss Ratio for Insurers

Requires health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets.
Implementation: Requirement to report medical loss ratio effective for 2010; requirement to provide rebates effective beginningJanuary 1, 2011

Closing the Medicare Drug Coverage Gap

Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
Implementation: January 1, 2011

Medicare Payments for Primary Care

Provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.
Implementation: January 1, 2011 through December 31, 2015

Medicare Prevention Benefits

Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment.
Implementation: January 1, 2011

Center for Medicare and Medicaid Innovation

Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality.
Implementation: Center established by January 1, 2011

Medicare Premiums for Higher-Income Beneficiaries

Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.
Implementation: January 1, 2011

Medicare Advantage Payment Changes

Restructures payments to private Medicare Advantage plans by phasing-in payments set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.
Implementation: January 1, 2011

Medicaid Health Homes

Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home and provides states taking up the option with 90% federal matching payments for two years for health home-related services.
Implementation: January 1, 2011

Chronic Disease Prevention in Medicaid

Provides 3-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets.
Implementation: January 1, 2011

CLASS Program

Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).
Implementation: January 1, 2011

National Quality Strategy

Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.
Implementation: Initial strategy due to Congress by January 1, 2011

Changes to Tax-Free Savings Accounts

Excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a Health Reimbursement Account or health Flexible Spending Account and from being reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account. Increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the amount used.
Implementation: January 1, 2011

[RUMMYisFROSTED]

1. Looks great!

[golfguru]

2. Would look even better if the HCR bill had

limits on rate increases by the private for profit health insurance corporations.
There are NO LIMITS in the bill!
They can raise them until that 15% administrative allowance will meet their
profit goals.

Profits on backs of people's health should be banned and made illegal.

[ProSense]

4. "limits on rate increases by the private for profit health insurance corporations." There are

new rules limiting rate increases:

White House White Board: Health Reform & Rate Review

[golfguru]

5. A much better clause would have been to limit increases to CPI

You can have review boards coming out of your ears, if there is no law
which positively dictates the size of increases allowed, you can bet your bippy
the rate increases will far exceed the CPI. It has already taken place for 2011
rates from my insurance provider.

[Igel]

10. Sure it would.

On the other hand, limiting rates to the CPI would probably require that users as a whole limit any increase in their claims--including both claims for the same services they've been received plus any claims for new services--to the CPI.

[crim son]

3. These would all be fan-fucking tastic if nobody got sick

until they were eligible for Medicare.

[Liberal_Stalwart71]

6. Thanks so much for this!!! n/t

[ProfessionalLeftist]

7. For-profit insurers will game the system by moving more administrative

and other costs into the "medical loss ratio" column - so they can meet the 80-85% requirement for MLR.

Do you know what the MLR is for Medicare? I think it's something like 97%. It puts the for-profit pigs to shame.

[golfguru]

9. If they double the rates, that 15% suddenly becomes 30%

[annabanana]

15. They can only do that with the collution of individual State legislatures

and Insurance commissioners. The State commish's have held the line thus far. Would you believe that Ins companies tried to get them to classify lobbying as a "medical expenditure"?

[littlewolf]

8. also if you have Health savings accounts you have to

have a 'script from a DR. to buy OTC meds ....:<

[RedSpartan]

11. That's the last one listed.

I have a HC spending account. Forgive me, but I don't get this requirement. Can anyone explain it to me?

[littlewolf]

14. Not sure .... but if I had to guess ....

HC spending accounts are tax free .... for every dollar not used in that account is a dollar subject to taxes ...
but that is a WAG (wild --- guess) .... and is am kinda suspicious and don't put anything past Gov't on taxes ...
waiting for the feds to get on the unused gift card scam ....

[jwirr]

12. This should help many. I have some questions though. First does

the CLASS program replace what we already have in medicaid?

Second, what is a medicaid health home?

Finally, when they talk about the primary care giver are they talking about parents also? I took care of my daughter 24/7 for 45 years and the most I ever made was something like $.45 an hour. It is also why I am not receiving the minimum social security. Thanks for nothing jwirr! Yes, I am bitter but I will tell you I would do it again. She is healthier than if she had been in one of those "institutions" prisons.

[underpants]

13. I've seen the drop in the donut hole to 50% on many policies of late

good for them.

good stuff. I really like the means testing for Medicare.