Essentials of Healthcare Reform HS: 345 Assignment 2

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Assignment 2: Overview of Healthcare Reform

Assignment 1 Learning Objectives Overview of Healthcare Reform Sources of Law Governing Reform Timeline of Reform PHSA Mandates Insurance Definitions and Applicability Excepted Benefits

Healthcare Reform: Sources of Law Patient Protection and Affordable Care Act Health Care and Education Reconciliation Act Affordable Care Act Amends Several Major Laws: –IRC, ERISA, SSA, PHSA, FLSA HHS, DOL, IRS

2010 Changes Dependent Coverage Age Extension ERRP High Risk Pools Healthcare.gov Patient Protections PCE Prohibition Lifetime Limits Annual Restrictions Rescission Prohibition Automatic Enrollment Preventive Care

2011 Changes HSA Tax Increase OTC Reimbursement Rules MLR Regulations Small Business Grants (pending) Four-Page Summary of Benefits W-2 Reporting (exceptions created) 2012 Changes

2013 Changes Health FSA Cap for Cafeteria Plans Notice of Exchange HIPAA Regulations Increase in Medical Deduction Fair Premiums Reporting Requirements Exchanges Individual Mandate 2014 Changes

2014 Continued Play or Pay Tax PCE Total Prohibition Annual Limits Prohibition Waiting Period Limits Availability and Renewability Requirements Clinical Trial Coverage Comprehensive Coverage

Provisions of Healthcare Reform What coverage do mandates and other provisions of healthcare reform apply to? Answer: Group Health Plans, Individual Policies, Self-Insured Plans, Insurers, Church Group Plans, Wellness Programs that are attached to a group health plan, Governmental Health Plans

ERISA Definition of Group Health Plan ERISA & PHSA Definition –Employee Welfare Benefit Plan? Plan, Fund, Program Maintained by Employer Benefits Provided to Participants or Beneficiaries

Codes Definition of Group Health Plan A Plan (including a self-insured plan) of, or contributed by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families.

Excepted Benefit Types Accident-Only Disability Income Liability Insurance Worker’s Comp Automobile Medical Credit-Only On-Site Medical Clinics Limited-Scope Benefits Noncoordinated Benefits Certain Supplemental Benefits –Medicare and Tricare Supplements –Safe Harbor Rules

Immediate Changes to Social Programs Changes to Medicare –Improving of Quality of Care –Reform of Healthcare Delivery System –Pricing Services and Modernizing Financing Systems –Fighting Waste, Fraud, and Abuse Changes to Medicaid and CHIP –Expansion of both programs