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Sibelius Watch
Under Construction! Note: You can click the headers of the table to resort. You can also filter by keyword by typing into the search box. |
| Type | Responsibility | Statute Section | Due Date | Status | Responsible Entity |
|---|---|---|---|---|---|
| Type | Responsibility | Statute Section | Due Date | Status | Responsible Entity |
| Insurance Reform | Establishes grants to states for ombudsman or consumer assistance offices to receive and respond to inquiries and complaints about health insurance coverage under federal and state requirements. | 03/25/2010 | Completed | ||
| Insurance Reform | Requires plans to justify unreasonable premium increases to HHS and the states; authorizes grants to states to strengthen provisions for rate review. | PPACA Sec. 1003, p. 21 , adds Sec. 2794 to the PHS Act | 03/25/2010 | Completed | |
| Insurance Reform | Temporary high risk pool for people with pre? existing conditions (sunsets in 2014). | PPACA Sec. 1101, p. 23 | 06/23/2010 Effective 90 days after enactment | ||
| Insurance Reform | Temporary reinsurance pool for retired employees 55 and older who do not qualify for Medicare (sunsets in 2014). | PPACA Sec 1102, p. 25 | 06/23/2010 Effective 90 days after enactment | ||
| Insurance Reform | HHS to establish a website to help customers identify affordable health insurance coverage options, including information on co?payments and Medical Loss Ratio. | PPACA Sec. 1103, p. 28 | 07/1/2010 | ||
| Insurance Reform | Requires health plans to have an effective coverage and claims appeals process. | PPACA Sec. 1001, p. 19, adds Sec. 2719 to the PHS Act | 09/25/2010 (Effective six months after enactment) | ||
| Insurance Reform | Prohibits denial of coverage for children with preexisting conditions. | PPACA Sec. 10103(e), p 777, adds Sec. 2709 to the PHS Act | 09/25/2010 (Effective six months after enactment) | ||
| Insurance Reform | Prohibits rescissions except in the case of fraud. | PPACA Sec. 1001, p. 13, adds Sec. 7212 to the PHS Act; HCERA Sec. 2301, p. 53 | 09/25/2010 (Effective six months after enactment) | ||
| Insurance Reform | Health plans to begin reporting MLR to the Secretary. | PPACA Sec. 10101(f), p. 767, adds Sec. 2718 to the PHS Act | 09/25/2010 (Effective six months after enactment) | Secretary | |
| Insurance Reform | Extension of coverage of children to 26th birthday on family policy. | PPACA Sec. 1001, p. 14, adds Sec. 2714 to PHS Act; HCERA Sec. 2301(a), p. 53 | 09/25/2010 (Effective six months after enactment) | ||
| Insurance Reform | Insurers may not establish lifetime limits or unreasonable annual limits on the value of benefits. Prior to January 1, 2014, HHS must approve any limits established by insurers. | PPACA Sec. 10101(a), p. 765; HCERA Sec. 2301, p. 53 | 09/25/2010 (Effective six months after enactment) | ||
| Medicare | Creates Medicare hospital value?based purchasing program. | PPACA Sec. 3001, p. 235 | 10/1/2012 (for fiscal year 2013) | ||
| Delivery System Reforms | Establishes the Patient Centered Outcomes Research Institute as a non?profit entity and sets requirements and limitations on the use of comparative effectiveness research | PPACA 1002, p. 20, adds Sec. 2793 to the PSH Act | 2010 | ||
| Medicare | Beneficiaries who reach the Part D doughnut hole receive a $250 subsidy; first step in closing the gap by 2020 | HCERA Sec. 1011, p.9 | 2010 | ||
| Medicare | Medicare Advantage benchmarks frozen at 2010 level (HCERA Sec. 1102(b), p. 12, repeals PPACA Sec. 3201 and 3203). Coding intensity adjustments required | HCERA Sec. 1102(e), p. 18 | 2011 | ||
| Delivery System Reforms | HHS to develop national quality strategy based on delivery, outcomes and population health | PPACA Sec. 3011, p.260 | 2011 | ||
| Revenue | New tax on pharmaceutical manufacturers and importers () | PPACA Sec. 9008, p. 741; HCERA Sec. 1404, p. 36 | 2011 | ||
| Insurance Reform | Requires a rebate for MLR less than 80% in individual and small group market and 85% in large group market. | PPACA Sec. 1001, p. 19, adds Sec. 2718 to the PHS Act | 2011 | ||
| Medicare | Provides coverage of comprehensive health risk assessment and personalized prevention incentives. Increases Medicare coverage to 100% for certain preventive services and wellness coverage . | PPACA Sec. 4103, p. 435; Sec. 4104, p. 439 | 2011 | ||
| Medicare | Provides a 10% Medicare bonus for primary care services in all areas and for procedures performed by general surgeons in shortage areas | PPACA Section 5501, p. 534 | 2011 | ||
| Delivery System Reforms | Establishes center for Medicare and Medicaid Innovation within CMS to test payment and service delivery models. | PPACA Sec. 3021, p. 271 | 2011 | ||
| Mandates and Subsidies | Provides tax credits to subsidize employer coverage by companies with no more than 25 employees with average annual wages per employee of less than $50,000 | PPACA Sec 1421, p. 119 | 2011 | ||
| Delivery System Reforms | Reduces Medicare payments to hospitals for preventable readmissions | PPACA Sec. 3025, p. 290; Sec. 10309, p. 824 | 2011 | ||
| Delivery System Reforms | Establishes community collaborative care networks | PPACA Sec. 10333, p. 852 | 2011 | ||
| Delivery System Reforms | Creates a community?based transitions of care program | PPACA Sec. 3026, p. 295 | 2011 | ||
| Medicare | Establishes an open enrollment period from Oct. 15 to Dec. 7, starting with 2012 plan year. | PPACA Sec. 3204(b), p. 338 | 2011 | ||
| Delivery System Reforms | Establishes shared savings program to promote Accountable Care Organizations | PPACA Sec. 3022, p. 277 | 2012 | ||
| Delivery System Reforms | Creates an Independence at Home demonstration program | PPACA Sec. 3024, p. 286 | 2012 | ||
| Revenue | Imposes a fee of $1 per insured life for policy years after October 1, 2012 and $2 for subsequent years to fund Patient?Centered Outcomes Research Trust Fund | PPACA Sec. 1183, p. 626, adds Sec. 4375 to the IRC | 2012 | ||
| Medicare | Medicare Advantage ? begin phase?in of new benchmarks, quality bonus payments, and rebate calculation | HCERA Sec. 1102(b), p. 12, 1102(c), p. 15, & 1102(d), p. 17) | 2012 | ||
| Insurance Reform | Establishes electronic funds payment requirements for health care payment and remittance | PPACA Sec. 1104, p. 28 | 2012 | ||
| Medicaid | Requires Medicaid payment for primary service to be paid at Medicare rates; applicable for 2013 and 2014 only | HCERA Sec. 1202, p. 24 | 2013 | ||
| Delivery System Reforms | Creates pilot program for bundled payments | PPACA Sec. 3023, p. 281; Sec. 10308, p. 823 | 2013 | ||
| Revenue | Eliminates employer deduction of expenses allocable to Medicare Part D | PPACA Sec. 9012, p. 750; HCERA Sec. 1407, p. 39 | 2013 | ||
| Revenue | Increases Medicare payroll tax on incomes over $200K for individuals and $250K for couples | PPACA Sec. 9015, p. 752; HCERA Sec. 1402, p.32 | 2013 | ||
| Medicare | Establishes Medicare Part D coverage gap discount program | PPACA Sec. 3301, p. 343; HCERA Sec. 1101, p. 8 | 2013 | ||
| Revenue | Establishes new Medicare tax on investment income for high?income individuals | HCERA Sec. 1402, p. 32 | 2013 | ||
| Revenue | Limits the deductibility of executive compensation of health insurance providers to $500,000 for 2013 income or payments of deferred compensation for services rendered after January 1, 2010 | PPACA Sec. 9014, p. 750 | 2013 | ||
| Exchanges, Qualified Health Plans, and Markets | Limits annual salary reduction contributions by an employee to a flexible health spending arrangement under a cafeteria plan to $2,500. Allows an annual inflation adjustment to such amount after 2013. | PPACA Sec. 9005, p. 736; Sec. 10902, p. 898; HCERA Sec. 1403, p. 35 | 2013 | ||
| Exchanges, Qualified Health Plans, and Markets | Establishes grant and loan program to support creation of Co?ops | PPACA Sec. 1322, p. 69; Sec. 10104, p. 778 | 2013 | ||
| Revenue | Increases threshold for deduction of unreimbursed medical expenses to 10%; waives the increase for people 65 and older | PPACA Sec. 9013, p. 750 | 2013 | ||
| Revenue | Establishes 2.3% tax on medical device manufacturers and importers | HCERA Sec. 1405, p. 36 | 2013 | ||
| Revenue | Phase?in of annual fee on health insurers begins | PPACA Sec. 9010, p. 747; Sec. 10905, p. 899; HCERA Sec. 1406, p. 37 | 2014 | ||
| Medicaid | Medicaid expansion for adults up to 133% of the poverty level, including those without children | PPACA Sec. 2001, p. 153; Sec, 10201, 799; HCERA Sec. 1201, p. 23 | 2014 | ||
| Medicare | Medicare Advantage plans required to have an 85% MLR | HCERA Sec. 1103, p. 19 | 2014 | ||
| Medicare | Medicare DSH payments are reduced | PPACA Sec. 3133, p. 314, & Sec. 10316, p. 828; HCERA Sec. 1104, p. 19 | 2014 | ||
| Medicaid | Medicaid DSH payments are reduced | PPACA Sec. 2551, p. 194; Amended by HCERA Sec. 1203 p. 25 | 2014 | ||
| Exchanges, Qualified Health Plans, and Markets | Permits states to create Basic Health Plan for uninsured individuals between 133% | PPACA Sec. 1331, p. 81 | 2014 | ||
| Insurance Reform | Limits coverage waiting periods to 90 days | PPACA Sec. 1201, p. 43, adds Sec. 2708 to PHS Act | 2014 | ||
| Insurance Reform | Requires states to establish a transitional reinsurance program for high?risk individuals in the individual market; funded through assessment on insurers | PPACA Sec. 1341, p.90 | 2014 | ||
| Insurance Reform | Allows limited rating variation based on age, premium rating area, family composition and tobacco use in the individual and small group markets | PPACA Sec. 1201, p. 37, adds Sec. 2701 to PHS Act | 2014 | ||
| Insurance Reform | Requires guaranteed issue and renewability | PPACA Sec. 1201, p. 38, adds Sec. 2702 and 2703 to PHS Act | 2014 | ||
| Insurance Reform | Prohibits annual and lifetime dollar coverage caps | PPACA Sec. 10101(a), p.765, adds Sec. 2711 to the PHS Act; HCERA, Sec. 2301, p. 53 | 2014 | ||
| Insurance Reform | Prohibits denial of coverage for adults with pre?existing conditions | PPACA Sec. 1201, p. 36, adds sec. 2704 to the PHS Act | 2014 | ||
| Mandates and Subsidies | Phase?in of the individual mandate begins | PPACA Sec. 1501(b), p. 126; Sec. 10106(b), p. 791; HCERA, Sec. 1002, p. 4 | 2014 | ||
| Mandates and Subsidies | Establishes cost sharing limits: 100?200% FPL ? 1/3 of the H.S.A. limits; 200?300% FPL ? 1/2 H.S.A. limits; 300?400% FPL ? 2/3 H.S.A. limits | PPACA Sec. 1402, p. 102; HCERA, Sec. 1001, p. 3 | 2014 | ||
| Mandates and Subsidies | Provides premium assistance tax credits to families with household incomes between 133% and 400% FPL | PPACA Sec. 1401, p. 95; Sec. 10105, p. 788; HCERA Sec. 1001, p. 2; Sec. 1004, p. 6 | 2014 | ||
| Exchanges, Qualified Health Plans, and Markets | Essential health benefits offered by Qualified Health Plans through the exchange. Requires four tiers of benefits based on actuarial value of benefits: Bronze 60%, Silver 70%, Gold 80%, Platinum 90%. All exchange plans must offer at least Silver and Gold options | PPACA Sec. 1302, p. 45; Sec. 10104, p. 778. | 2014 | ||
| Exchanges, Qualified Health Plans, and Markets | Allows employers to offer rewards to employees who participate in a wellness program | PPACA Sec. 1201, p. 38, adds Sec. 2705 to PHS Act | 2014 | ||
| Exchanges, Qualified Health Plans, and Markets | Qualified health plans (QHPs) begin to offer coverage in the exchange. | PPACA Sec. 1301, p. 44 | 2014 | ||
| Exchanges, Qualified Health Plans, and Markets | State?based exchanges and SHOP exchanges begin to operate. | PPACA Subtitle D, Part II, p. 55; Sec. 10104, p. 778; HCERA, Sec. 1204, p. 27 | 2014 | ||
| Mandates and Subsidies | Establishes penalties for employers not offering coverage and employers offering coverage with one or more employees receiving subsidized coverage. | PPACA Sec. 1513, p. 135; Sec. 10106(e) & (f), p. 792, & (i), p. 796; HCERA Sec. 1003, p. 5 | 2014 | ||
| Delivery System Reforms | [2015] Reduces payments by 1% for excessive hospital acquired conditions | PPACA Sec. 3008, p. 258 | 2015 | ||
| Exchanges, Qualified Health Plans, and Markets | States may limit small employer size to 50 employees in the small group market | PPACA Sec. 1304, p. 54 | 2016 | ||
| Mandates and Subsidies | Individual mandate penalties increase to $695 or 2.5% of income | PPACA Sec 1501(b), p. 126; Sec. 10106(b), p. 791; HCERA, Sec. 1002, p. 4 | 2016 | ||
| Exchanges, Qualified Health Plans, and Markets | States may form interstate compacts | PPACA Sec. 1333, p. 88 | 2016 | ||
| Exchanges, Qualified Health Plans, and Markets | States may permit employers with more than 100 employees to obtain coverage through state exchanges | 2017 | |||
| Revenue | Excise tax imposed on high?cost employer?sponsored health plans | PPACA 9001, p. 729; Sec. 10901, p. 897; HCERA Sec. 1401, p. 31 | 2018 | ||
| Type | Responsibility | Statute Section | Due Date | Status | Responsible Entity |