Duane Morris LLP - Healthcare Reform Timeline

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Healthcare Reform Center

Healthcare Reform Timeline - Changes Affecting Physicians

2010

Provide a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 and gradually eliminate the Medicare Part D coverage gap by 2020. (Effective March 23, 2010).
Improve care coordination for dual eligibles by creating a new office within the Centers for Medicare and Medicaid services, the Federal Coordinated Health Care Office.
New physician-owned hospitals in Medicare and required hospitals to have 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 if certain conditions are met.
Increase the Medicaid drug rebate percentage for brand name drugs to 23.1%, 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 (including those dually eligible for Medicare and Medicaid).
Increase workforce supply and support training of health professionals through scholarships and loans.

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 to develop a national strategy to improve the nation's health.
Require pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begin phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
Provide a 10% Medicare bonus payment to primary care physicians and to general surgeons practicing in health professional shortage areas. (Effective 2011 through 2015).
Restructure payments to Medicare Advantage (MA) plans by setting payments to different percentages of Medicare fee-for-service (FFS) rates.
Freeze the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels, and reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.
Create an Innovation Center within the Centers for Medicare and Medicaid Services.
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.
Improve access to care by increasing funding by $11 billion for community health centers and the National Health Service Corps over five years; establish new programs to support school-based health centers and nurse-managed health clinics.
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.
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).

Effective January 1, 2013

Increase Medicaid payments for primary care services provided by primary care doctors for 2013 and 2014.
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. (Issue recommendations beginning January 2014).

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.