ACA Implementation Timeline

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1 ACA Implementation Timeline Published: March 5, 2013 Updated: July 5, 2013 Producer: Sophie Novack Director: Jessica Guzik National Journal Presentation Credits

2 Most ACA Reforms Implemented Jan Jan Establishment of pilot Medicare bundled payment program Phase-out of Medicare drug coverage gap Increase in Medicare Part A (hospital insurance) tax rate Increase in Medicaid coverage of preventive services Increase in Medicaid payments for primary care Elimination of tax-deduction for employer retiree coverage subsidy Creation of 2.3% excise tax on medical devices Cap on flexible spending accounts April 2013 Requirement to disclose financial relationships between health entities and manufacturers/ distributors Implementation Timeline for Major ACA Provisions Medicare/Medicaid Insurance Finance/Taxes Guarantee of insurance availability regardless of health status Prohibition of annual limits on coverage Enforcement Implementation of employer of health insurance exchanges requirements Provision of health insurance premium and cost sharing subsidies Imposition of fees on health insurance sector Creation of essential health benefits package Requirement of health insurance (individual mandate) Requirement of minimum 85% medical loss ratio for Medicare Advantage plans Expansion of Medicaid coverage July 2014 Establishment of wellness programs participation incentives July 2013 Creation of Consumer Operated and Oriented Plan (CO-OP) for member-run health insurance companies Oct Reduction in Medicare and Medicaid Disproportionate Share Hospital (DSH) allotments Oct Reduction in Medicare payments to hospitals for hospitalacquired conditions by 1% Jan Enforcement of employer insurance requirements 2

3 Focus on Medicare and Medicaid Reform in 2013 Jan Establishment of pilot Medicare bundled payment program Phase-out of Medicare drug coverage gap Increase in Medicare Part A (hospital insurance) tax rate Increase in Medicaid coverage of preventive services Increase in Medicaid payments for primary care Elimination of tax-deduction for employer retiree coverage subsidy Creation of 2.3% excise tax on medical devices Key Provisions Implemented in 2013 Medicare/Medicaid Insurance Finance/Taxes Establishes national pilot program to make bundled payments for health services Phases-in subsidies for brand-name prescriptions filled in Medicare Part D coverage gap Increases Medicare Part A (hospital insurance) tax rate on wages by 0.9% on higher earners Increases federal matching payments for preventive services in Medicaid for states eliminating cost-sharing Cap on flexible spending accounts April 2013 Requirement to disclose financial relationships between health entities and manufacturers/ distributors July 2013 Creation of Consumer Operated and Oriented Plan (CO- OP) for member-run health insurance companies Oct Reduction in Medicare Disproportionate Share Hospital (DSH) allotments Reduction in Medicaid Disproportionate Share Hospital (DSH) allotments Increases Medicaid payments for primary care to 100% of the Medicare payment rate for 2013 and 2014 Eliminates tax-deduction for employers receiving Medicare Part D retiree drug subsidy payments Reduces Medicare DSH payments by 75%, then increases payments based on uninsured population and care provided Reduces states Medicaid DSH allotments; Secretary determines how to distribute reductions 3

4 Focus on Health Insurance Expansion in 2014 Key Provisions Implemented in 2014 Medicare/Medicaid Insurance Insurance companies prohibited from refusing coverage or charging more due to individual s gender or health status Dollar limit on coverage prohibited Jan Guarantee of insurance availability regardless of health status Prohibition of annual limits on coverage Implementation of health insurance exchanges Provision of health insurance premium and cost sharing subsidies Individuals and small businesses can compare and shop for insurance plans in competitive marketplace Small business tax credit increased to 50% of employer s contribution for insurance to employees Individuals with incomes % of federal poverty level (FPL) eligible for tax credits to buy insurance through exchanges; costsharing subsidies available to those with incomes up to 250% of FPL Individuals are required to have basic health insurance or pay a fee, with certain exemptions Individuals with incomes up to 133% of FPL are eligible for Medicaid if states opt in to Medicaid expansion Imposition of fees on health insurance sector Creation of essential health benefits package Requirement of health insurance (individual mandate) Requirement of minimum 85% medical loss ratio for Medicare Advantage plans Expansion of Medicaid coverage July 2014 Establishment of wellness programs participation incentives Oct Reduction in Medicare payments to hospitals for hospitalacquired conditions by 1% 4

5 Final ACA Provisions Implemented Through 2018 Implementation Timeline for Major ACA Provisions, Medicare/Medicaid Insurance Jan Increase federal match for Children s Health Insurance Program (CHIP) Physician Quality Reporting System Basic Health Plan Operational Increase in CHIP match rate up to a cap of 100% Reduces Medicare payments to providers for not successfully reporting measures States have option to create Basic Health Plan for individuals with incomes % of FPL Enforcement of employer insurance requirements Certain larger employers must pay fee if they don t provide affordable coverage to employees Health Care Choice Compacts Jan Permits states to form health care choice compacts and allows insurers to sell policies in any state participating Tax on high-cost insurance Jan 2018 Imposes excise tax on employer-sponsored coverage that costs over $10,200 for individuals and $27,500 for families 5

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