§§1501, 10106; HCERA §§1002, 1004
Your New Health Care System
§3021 §5605
§3403, 10320 §6301 §6301 §8002 §1411 §4002
President
§8002
§8002
§8002
§8002
§8002
§3012
§1411
§1313, 10104
§1313, 10104
§§1322, 10104
§1322, 10104
Private Purchasing Council §1322
Internet Portal §1311
§§1201, 1301,1302, 1311, 1312, 1313, 1321, 1323, 1334, 1411, 1413, 10104; HCERA §1204
Small Business Health Options Program
Data Collection
§1311
§1311
§2602
§1001, 10101
MEWA Health Plans
§1511 §1512
§1311
§§9015, 10906; HCERA §1402
Rationing Potential
Mandates
Involvement in Health Insurance Market
Taxes & Monetary Fees/ Penalties/Cuts Trust Fund (Rationing Potential) Other New Trust Funds/ Monetary Benefits
Government with Expanded Authority/ Responsibility
Mandates, Regulations, & Taxes
Government Financial Entity with New Inflows/ Outflows State/Territory with Expanded Authority/ Responsibility
Regulations/ Requirements/Mandates Reporting Requirements
Unchanged Private Entity
Money Flows Consultation/Advisory/ Info Sharing Structural Connections (Includes Existing)
Special Interest Provisions
Oversight
10% Tax On Indoor Tanning Services:
§1512 §§9017, 10907
§§1311, 1411, 1501, 9003-9005, 9013, 9015, 9017, 10106, 10902, 10906, 10907; HCERA §§1002, 1004, 1402, 1403
§§9017, 10907 §9013
Flexible Spending Arrangement §9005, 10902; HCERA §1403
§§9005, 10902; HCERA §1403
New Relationships
Private Entity with New Mandates/ Regulations/ Responsibilities
§§1421, 10105
Small Business Employees
Individuals
§3311
Private
Small Business Health Insurance Tax Credit
FSA Contribution Limit: $2,500 §§9005, 10902; HCERA§1403
Patients
Only Medical Expenses Above 10% of Income (AGI) are Tax Deductible
§§9010, 10905; HCERA §1406
Medicare Beneficiaries §3311
Expanded Government
§1421, 10105
§§9015, 10906; HCERA §1402
§§1304, 1311, 1421, 1512, 10105
§1512
§9003
§9002
HCERA §1402
Medicare Payroll Tax Increase: 0.9%
Large Business Employees
§§1501, 10106; HCERA §§1002, 1004
Small Employers
§§1511, 1512, 1513, 9001, 9002, 10106, 10901; HCERA §§1003, 1401
§1511, 1512
3.8% Investment Income Tax
§9004
§1511
HSA Use Restriction
§1513, 10106
§1512
Misuse of HSA Funds
Mandates, Regulations, & Taxes
§1501
§3311 §3311
§§1401, 1412, 10105; HCERA §§1001, 1004
§§1513, 10106; HCERA: §1003
§§1201, 1301
§3311
§3004
§§1001, 10101
§3004 §3004 §3004
New Government
§§1514, 10106
§3301; HCERA §1101
Health Insurance Policy Holder
Individual Mandate: Buy Health Insurance
§§9001, 10901; HCERA §1401
§1411
§2701
“Cadillac Plans” Tax
§§1001, 10101
§1301
§§9001, 10901; HCERA §1401
§§9001, 10901; HCERA §1401
§§9003, 9004
§§1001, 10101
Self-Insured Health Plans
Employers
Health Savings Accounts
“Excessive Profits” Premium Tax Credit Subsidies
§§1304, 1511, 1512, 1513, 1514, 10106
HCERA §1402
Subsidy: Medicare Part D Drug Program “Donut Hole”
§3007 §3004 §3004 §3004 §3004 §3004
Medicaid Quality Measurement Program
§§1402, 1412; HCERA §1001
§9002
§1511
§9004
§3004, 3005
§3301; HCERA §1101
§2701
Subsidies: Out-of-Pocket Expenses
W2 Health Insurance Disclosure
§§1513, 10106; HCERA §1003
Large Employers
§§1201, 1301, 1511
§§1001, 1201, 1252, 1301, 1334, 1341, 3311, 9001, 9010, 10101, 10104, 10901, 10905; HCERA §§1401, 1406
§9003
§§3007
Hospital Quality Reporting Program
Medicare Prescription Drug and MA-PD Complaint System
§§3201, 10318; HCERA §1102; CBO Cost Estimate, 3/20/10
§1511
Large Group Market
Mandates, Regulations, Required Benefits, & Taxes
§§1001, 10101
§§3007
§3311
§§9010, 10905; HCERA §1406
§§1401, 1412, 10105; HCERA §§1001, 1004
§§3002, 10327, 10331 §§3002, 10327, 10331
Physician Value-Based Payment Modifier
Title III; CBO Cost Estimate, 3/20/10
Medicare Advantage Cuts: $205.9bn
§2701
StateSpecific Adult Health Quality Measures
(includes MA cuts)
§§3201, 10318; HCERA §1102
Title III, §2602
§2701
§2701
§§3002, 10327, 10331
Hospital Compare Website §3001
Annual Fee
§2701
§3004
Physician Quality Reporting System
Medicare Cuts: $528.9bn
§§9010, 10905; HCERA §1406
§2701
§3004
§3005
§§1311, 3002, 3003, 10327, 10331
Long-Term Care Hospitals
§3005
Inpatient Rehabilitation Facilities
§3005
Physicians
§3005
Medicare
Title III
Medicare Part C & Part D Insurers
§2701
PPS-Exempt Cancer Hospitals
§3004
§§2602, 2701, 2703, 3011
§3022, 10307
§§1201, 1301, 1304
Employer Mandate: Provide Health Insurance
Mandatory Worker AutoEnrollment
§1301, 1304, 1342
Health Insurance Companies
§3311
§2701
Hospice Programs
§3007
§2602
§§3001, 10335
§§3004, 3005
§3311
§§1311
§2703
State Medicaid Agencies
§§2001-2004 CBO Cost Estimate, 3/20/10
§3001
Hospital Value-Based Purchasing Program
Medicare Administrative Contractors
§§1311, 3001-3006, 3311, 9008, 9009, 10327, 10331, 10335, 10904; HCERA §§1404, 1405
Public Data Disclosure System §3006, 10301
§§3022, 10307
§3006
§§3001, 10335
§§3006, 10301
§1511
§§1311, 3001, 10335
§§3001, 10335
§2703
Medicaid Expansion: +16 million
§1342
Hospitals
Mandates, Regulations, Taxes, & Payment Cuts
Demonstration Program §3001
§§3001, 10335
Small Group Market §§1514, 10106
§§1402, 1412; HCERA §1001
Health Industry
§1341, 10104
§§3006, 10301
Title II; §§1413, 3011
§§1301, 6605
§1201, 1301, 1304, 1342
§2703
§§3006, 10301
Medical Device Manufacturers
Medicaid/ CHIP
FFS Accountable Care Organizations Program
17
§1334, 10104
§§3006, 10301
Medicaid Health Home Program
§2602
§§2001-2004
NonHospital Value-Based Purchasing Program
§§3006, 10310
§§1311, 1413
§§3021, 10305, 10306
§§3013, 3021, 3026, 3403, 10305, 10306, 10320
§3021
Individual Market
§6605
§§1201, 1301, 1304
§2703
§§3006, 10301
Skilled Nursing Facilities
CMS
§2602
§2602
§§3022, 10307
§§9009, 10904
§9008; HCERA §1404
§§9009, 10904; HCERA §1405
Ambulatory Surgical Centers
Center for Medicare & Medicaid Innovation
§§1001, 1101, 1201, 1251, 10101, 10103; HCERA §2301
§§1001, 10101
4
§3403
§3026
§2602 §3011
Medical Device Excise Tax
§§1331, 3403, 10104
§3026
5 2 0 3 , 52 0 4 , 5 20 5 , 5311
§3403, 10320
CommunityBased Care Transitions Program
§2703
§§3021, 10305, 10306
§§9015, 10906; HCERA §1402
Loan Repayment & Forgiveness Programs
Federal Coordinated Health Care Office
CMS Actuary
§3026
§3026, 6301
Insurance Mandates
§1342
§3013
§§9001, 10901; HCERA §1401
Risk Corridors
§1342
§1334, 10104
§1513, 10106
Medicare Part B Trust Fund
§§3403, 10320
Health Insurance CO-OP
§1322
§1421, 10105
CO-OP Advisory Board
§§1322, 10104
§§1341, 10104
§1321
§1313, 10104
§1322
§§1501, 10106; HCERA §§1002, 1004
§1313, 8002, 10104
§§9004, 9005; HCERA §1402
§§1341, 10104
§§1341, 10104
§§1311, 10104
§§1311, 10104
§1411
§1411
§3001
§§1401, 10105
§§1311, 10104
§§1331, 10104
§1323; HCERA §1204
§1323; HCERA: §1204
Government Health Benefit Exchanges
§1342
§§3403, 10320
Represents Bundles of Additional Entities
US Territories
§1323; HCERA: §1204
§3026
IPAB Consumer Advisory Council
Other Expansions
§1331, 10104
§1001
Eligibility Determinations
§1411
HHS Inspector General
§1411
§§3403, 10320
§§1341, 10104
§1411
§1561
§4302
Reinsurance Program
§§1301, 10104
Privacy Study
§3026
§3026, 3403, 6301,9015
§§1333, 10104
§§1333, 10104
§§1301, 1302, 1311, 10104
§1301
Health IT Policy Committee
§1561
§§1311, 10104
§1001
§3011
§3013
§1001
Health Care Choice Compacts
NAIC §§1333, 1341, 10104
Qualified Health Plans
§1411
§8002
§§3013, 10304
Value-Based Insurance Design & Coverage of Preventive Health Services
§1001
§4302
§3011
§3403
Medicare Part A Trust Fund
§§9001, 10901; HCERA §1401 §1333, 10104
Gold
§1311
§§3011, 3012
National Health Disparities Data Collection & Reporting System
National Health Strategy & Priorities Office
§§1201, 1301, 1302
§1001
§3011
§3011
§3013
Public Health Quality & Efficiency Measures Development Program
Health Care Quality Website
§10407
States
Platinum
§§1401, 3001, 3403, 6301, 10105, 10320
Vital Statistics Agencies
§6703
§§1311,1331, 1333,1341, 10104, 10407
§1001
Health & Human Services
§3011 §4302
§1331, 10104
§6703
§6703
§1411
§§3011, 4002, 4302
Silver
§1341, 10104
§1331, 10104
§1331, 10104
§4004
§4002
§3011
US Preventive Services Task Force
Secretary
Website “Transparency in Government” §1552
Public Health Service
§4001
§3011
§9008; HCERA §1404
Prevention Website §4004
§3011
Advisory Group on Prevention, Health Promotion, and Integrative and Public Health
§4305
4
§3403, 10320
§9008; HCERA §1404
§6703
§6703
§4305
§6301
§6301
Interagency Pain Research Coordinating Committee
§1001, 10101
Annual Fee
§3012
§§1001,1201, 1301, 1302
Bronze
State Surveyors
§§1201, 1301, 1302
§4001
§4001
§4001
§9008; HCERA §1404
Essential Health Benefits Package
§1311
Surgeon General
§§1331, 10104
§§1311, 10104
§3012, 3013, 6031
22
Optional Basic Health Program
§1302
AHRQ
§10407
§4001
§4305
Prevention & Public Health Fund
1 4 1 2 , 35 0 9 , 5 10 1 , 10104, 10221, 10334, 10413, 10501
GAO §1331, 10104
§6703
§6703
§4001
Rules for Insurance Claims Appeals
Pharmaceutical Companies
26
§4004
§4002
1 1 0 4 , 61 0 2 , 6 10 3
§§9009, 10904; HCERA §1405
§10407
§6301
National Prevention, Health Promotion, & Public Health Council
§4002
Other New Regulatory Programs
§3006
1 2 0 1 , 27 0 4 , 2 70 5 , 2 7 06 , 2707, 3023, 3024, 3113, 3140, 4204, 4206, 5304, 5509, 6112, 6114, 10212, 10221, 10315, 10323, 10326, 10504, 10607
§§1313, 1322
§2602
§2602
Elder Justice Coordinating Council
Elder Abuse, Neglect, & Exploitation Forensic Centers §6703
§10407
§4001
§§1001, 1302, 1311, 1511, 1512, 1513, 6605, 10101, 10106
Home Health Agencies
National Diabetes Mortality Statistics Education Training Program
§§1001, 4003, 4004, 4102, 10407
§1302
§3012
§§9009, 10904; HCERA §1405
§4102
§4004
CDC
§4004
§§4305, 6301, 10409
National Training Institute for Federal and State Surveyors §6703
Comptroller General
MedPAC
§10407
Other New Demonstration & Pilot Programs
§4102
Other New Bureaucracies
§6301
IPAB
Advisory Board on Elder Abuse, Neglect, & Exploitation §6703
§3311
MultiDisciplinary Panels on Improving LongTerm Care §6703
§6703
§3013
Labor Department
§§1513, 10106
National Diabetes Report Card Program §10407
§6703
§6301
§3012
Black Lung Benefits Act
Hours of Service Determination for Calculating Employer Mandate Penalty
§1312
§6301 §6301
PCORI Expert Advisory Panels
§6301
§1556
§5605
§6301
§6703
PCORI Trust Fund
§3012
NIH
§10409
§6301
§6703
Interagency Working Group on Health Care Quality
National Partnership on Prevention & Health Promotion
§4004
§1334, 10104
Justice Department
§10409
§10409
PCORI Methodology Committee
§§6301, 10602
§4004
PCORI
§1334, 10104
§4004
§3012
Cures Acceleration Network
§6301
§1312
§§1331, 10104
§4004
§6301
19
1 1 0 2 , 1 20 1, 2 0 0 6,3 1 3 7 , 3 20 1 , 3 3 0 1 , 6 0 0 1 , 9 0 0 1 , 9 0 1 0 , 9 0 14 , 9 0 2 3 , 1 0 2 0 1 , 1 0 3 1 7 , 1 0 3 2 3, 1 0 3 2 4, 1 0 5 0 2 , 1 0 6 0 1 , 1 09 0 1 , 1 0 90 5 ; HCERA 1 1 0 1 , 1 10 3 , 1106, 1203, 1406
§1333, 10104
National Oral Health Public Education Campaign
§4003 §4003
§6301
National Public Education Campaign on Prevention & Health Promotion
§5605
Congress §§1312, 1411, 3311, 5605, 8002
§§1331, 10104
§8002
Community Preventive Services Task Force
BENEFICIARIES: Mut ual of Omaha (NE); Drug Cos; NJ Drug Cos; AARP; Libby Mont anans; Physician-Owned Hospit als; Univ. of CT; Medigap Plans; Longshoreman Healt h Plans; Medicaid: HI, LA, MA, TN, VT; Medicare: CT, FL, MI, MT, ND
§8002
§6703
§8002
PCORI Board of Governors Office of Multi-State Qualified Health Plans
§6301
§6301
CLASS Independence Benefit Plan
Special Interest Provisions
§5605
Office of Tax Analysis
§8002
Cures Acceleration Network Review Board §10409
PCORI Website
§§1513, 10106; HCERA §1003
§§1401, 1402, 1411, 1412 1414, 1421, 1501, 9004, 9005, 10105, 10901; HCERA §§1401, 1402
§§1311, 1331, 4002, 8002, 10104
§8002
§8002
§6301
Personal Care Attendants Workforce Advisory Panel §8002
§5605
Congress Members & Personal Staff Mandate: Only Exchange Coverage
§9002
CLASS Independence Fund Board of Trustees
§8002
Treasury Department
Commission on Key Indicators
Key National Indicator System Implementation Institute
§§3103, 10320
§3403, 10320
CLASS Program
§8002
§1411 §8002
10323, 10333, 1 0 4 0 8 -1 0 , 1 0 4 1 3 , 10501, 10503
§8002 §8002
§8002
Office of Personnel Management
§8002
§8002
Social Security Administration
59
1 0 0 2 , 10 0 3 , 1 31 1 , 1 3 22 , 1 5 6 1 , 2 9 5 2 , 2 9 5 3 , 3 5 0 1 -6 , 3508, 4101, 4108, 4201, 4202, 4304, 5102 , 5206, 5 2 0 8 , 5 3 0 1 -5 3 0 3 , 5 3 0 5 , 5306, 5309 , 5313, 5 3 1 5 , 5 4 0 5 , 5 5 0 7 -8 , 5604, 6703, 10301
§8002
CLASS Independence Fund
§3403, 10320
State Protection & Advocacy Systems
IRS
Other New Grant Programs
§5605
§§ 3012, 3024, 3403, 4001, 8002, 10320
Eligibility Assessment System
CLASS Independence Advisory Council
Life Independence Accounts
§1411
§§1334, 10104
National Academy of Sciences
§1414 §1411
§1312
Homeland Security Department
§5605
§5605 §5605
§8002
§9013
§§1401, 1412, 10105; HCERA §§1001, 1004
AGI: Adjusted Gross Income AHRQ: Agency for Healthcare Research and Quality CDC: Centers for Disease Control & Prevention CHIP: Children’s Health Insurance Program CLASS: Community Living Assistance Services & Supports CMS: Centers for Medicare & Medicaid Services CO-OP: Consumer Operated & Oriented Program FFS: Fee-for-Service FSA: Flexible Spending Arrangement GAO: Government Accountability Office HCERA: Health Care & Education Reconciliation Act HHS: Health & Human Services Department
HSA: Health Savings Account IPAB: Independent Payment Advisory Board IRS: Internal Revenue Service MA-PD: Medicare Advantage Prescription Drug MedPAC: Medicare Payment Advisory Commission MERD: Medical Early Risk Detection EALORS: Executive Auxiliary Linked Office Regional Systems MEWA: Multiple Employer Welfare Arrangement NAIC: National Association of Insurance Commissioners NIH: National Institutes of Health PCORI: Patient-Centered Outcomes Research Institute PPS: Prospective Payment System
§§1402, 1412; HCERA §1001
Patient Protection & Affordable Care Act, P.L. 111-148; Health Care & Education Reconciliation Act, P.L. 111-152
Prepared by: Joint Economic Committee, Republican Staff Congressman Kevin Brady, Senior House Republican Senator Sam Brownback, Ranking Member