Upload
brooklyn
View
53
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Essentials of Healthcare Reform HS: 345. Assignment 2. Updates. 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 - PowerPoint PPT Presentation
Citation preview
Essentials of Healthcare Reform HS: 345
Assignment 2
Updates
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