Duane Morris LLP - Healthcare Reform Timeline

Home > Practices > Health Law Practice Group > Healthcare Reform Center > Healthcare Reform Compliance - For Hospitals

Healthcare Reform Center

Healthcare Reform Timeline - Changes Affecting Hospitals

2010

Medicare beneficiaries who reach the Part D coverage gap in 2010 are entitled to a $250 rebate and gradually eliminate the Medicare Part D "donut hole" by 2020. (Effective calendar year 2010).
Establishes a new office within the Centers for Medicare and Medicaid services, the Federal Coordinated Health Care Office for coordinating care for dual eligibles.
Reduce annual market based updates for inpatient hospital, home health, skilled nursing facility, hospice and other Medicare providers, and adjust for productivity.
Ban physician-owned hospitals in Medicare for those hospitals without a provider agreement in effect by December 31; limit the growth of certain grandfathered physician-owned hospitals.
Creates a state option to cover childless adults through a Medicaid State Plan Amendment.
Creates a state option to provide Medicaid coverage for family planning services to certain low-income individuals.
Creates a new option for states to provide CHIP coverage to children of state employees eligible for health benefits.
Increase the Medicaid drug rebate percentage for brand name drugs, increase the Medicaid rebate for non-innovator, multiple source drugs to 13% of average manufacturer price and extend the drug rebate to Medicaid managed care plans.
Provide funding for and expand the role of the Medicaid and CHIP Payment and Access Commission to include assessments of adult services.
Support comparative effectiveness research by establishing a non-profit Patient-Centered Outcomes Research Institute. (Effective March 23, 2010).
Establish the Workforce Advisory Committee to develop a national workforce strategy.
Increase workforce supply and support training of health professionals through scholarships and loans. (Effective March 23, 2010).
Impose additional requirements on non-profit hospitals. Impose a tax of $50,000 per year for failure to meet these requirements. (Effective March 23, 2010).

Effective January 1, 2011

Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations.
Estimate cost-sharing for Medicare covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waive the Medicare deductible for colorectal cancer screening tests.
Provide Medicare beneficiaries access to a comprehensive health risk assessment and creation of a personalized prevention plan and provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
Establish the National Prevention, Health Promotion and Public Health Council.
Prohibit Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.
Reduce annual market basket updates for Medicare providers.
Provide Medicare payments to qualifying hospitals in counties with the lowest quartile Medicare spending for 2011 and 2012.
Create an Innovation Center within the Centers for Medicare and Medicaid Services.
Prohibit federal payments to states for Medicaid services related to health care acquired conditions.
Create a new Medicaid state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home. Provide states taking up the option with 90% FMAP for two years for health home related services including care management, care coordination and health promotion.
Develop a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.
Establish the Community-based Collaborative Care Network Program to support consortiums of health care providers to coordinate and integrate health care services, for low-income uninsured and underinsured populations.
Establish a new trauma center program to strengthen emergency department and trauma center capacity.
Establish Teaching Health Centers to provide payments for primary care residency programs in community-based ambulatory care residency programs in community-based ambulatory care providers.

Effective January 1, 2012

Allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.
Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions.
Establish a hospital value-based purchasing program in Medicare and develop plans to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.
Create new demonstration projects in Medicaid to pay bundled payments for episodes of care that include hospitalizations (effective January 2, 2012 through December 31, 2016).
New demonstration project to make global capitated payments to safety net hospital systems (effective fiscal years 2010 through 2012).
To allow pediatric medical providers organized as accountable care organizations to share in cost-savings (effective January 1, 2012 through December 31, 2016).
To provide Medicaid payments to institutions of mental disease for adult enrollees who require stabilization of an emergency condition (effective October 1, 2011 through December 31, 2015).
Require enhanced collective and reporting of data on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations.
Make Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home and community-based care services equal to the cost-sharing for those who receive institutional care.

Effective January 1, 2013

Establish a national Medicare pilot program to develop and evaluate paying a bundled payment for acute, inpatient hospital services, physicians services, outpatient hospital services, and post-acute care services for an episode of care.
Require disclosure of financial relationships between physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.

Effective January 1, 2014

Establish an Independent Payment Advisory Board to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare.
Reduce Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increase payments based on the percent of the population uninsured and the amount of uncompensated care provided.
Expand Medicaid to all non-Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (MAGI) and provides enhanced federal matching for new eligibles.
Reduce states' Medicaid Disproportionate Share Hospital (DSH) allotments.

Effective January 1, 2015 and Beyond

Reduce Medicare payments to certain hospitals for hospital-acquired conditions by 1%. (Effective fiscal year 2015).

For additional information on any of the issues referenced on this page, please contact C. Mitchell Goldman, David E. Loder or the Duane Morris attorney with whom you are regularly in contact.