Legislation mandating additional reductions troy dizon dating scam

It's privately owned, and is not owned or operated by the US federal or state government. The following is a summary of every provision in the Patient Protection and Affordable Care Act HR3590. Requires all plans offering dependent coverage to allow unmarried individuals until age 26 to remain on their parents’ health insurance. Requires the Secretary to develop standards for use by health insurers in compiling and providing an accurate summary of benefits and explanation of coverage. Employers that provide health coverage will be prohibited from limiting eligibility for coverage based on the wages or salaries of full-time employees. The act appropriates billion for this fund and funds are available until expended. Establishes an Internet portal for beneficiaries to easily access affordable and comprehensive coverage options. Establishes a process to regularly update the standards and operating rules for electronic transactions and requires health plans to certify compliance or face financial penalties collected by the Treasury Secretary. Requires Exchanges to certify qualified health plans, operate a toll-free hotline and Internet website, rate qualified health plans, present plan options in a standard format, inform individuals of eligibility for Medicaid and CHIP, provide an electronic calculator to calculate plan costs, and grant certifications of exemption from the individual responsibility requirement. Improvement in determination of Medicare part D low-income benchmark premium. Voluntary de minimis policy for subsidy-eligible individuals under prescription drug plans and MA–PD plans. Special rule for widows and widowers regarding eligibility for low-income assistance. Improved information for subsidy-eligible individuals reassigned to prescription drug plans and MA–PD plans. Funding outreach and assistance for low-income programs. Improving formulary requirements for prescription drug plans and MA–PD plans with respect to certain categories or classes of drugs. Reducing part D premium subsidy for high-income beneficiaries. Elimination of cost sharing for certain dual-eligible individuals. Reducing wasteful dispensing of outpatient prescription drugs in long-term care facilities under prescription drug plans and MA-PD plans. Improved Medicare prescription drug plan and MA–PD plan complaint system. Uniform exceptions and appeals process for prescription drug plans and MA–PD plans. Office of the Inspector General studies and reports. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D. It would also incorporate a productivity adjustment into payment updates for Part B providers who do not already have such an adjustment. For higher-income beneficiaries who pay a higher Part B premium rate, freezes the income thresholds at 2010 levels through 2019. Congress would be allowed to consider an alternative provision on a fast-track basis. Health care delivery system research; Quality improvement technical assistance. Presentation of prescription drug benefit and risk information. Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals. In addition, the Secretary will provide guidance and relevant information to States and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults. Appropriates million each year for fiscal years 2010 through 2013 for expenditures for facilities and equipment. Such services would include a comprehensive health risk assessment. Removal of barriers to preventive services in Medicare. This section would authorize the Secretary to modify the coverage of any currently covered preventive service in the Medicare program to the extent that the modification is consistent with U. Preventive Services Task Force recommendations and the services are not used for diagnosis or treatment.

We don't offer professional official legal, tax, or medical advice. Most of what you need to know about the PPACA is contained in title I – Quality, Affordable Health Care For All Americans. The standards must be in a uniform format, using language that is easily understood by the average enrollee, and must include uniform definitions of standard insurance and medical terms. This information will include eligibility, availability, premium rates, cost sharing, and the percentage of total premium revenues spent on health care, rather than administrative expenses, by the issuer. The goal of this section is to make the health system more efficient by reducing the clerical burden on providers, patients, and health plans. Beginning in 2015, requires Exchanges to be self-sustaining and allows them to charge assessments or user fees. Requires drug manufacturers to provide a 50 percent discount to Part D beneficiaries for brand-name drugs and biologics purchased during the coverage gap beginning July 1, 2010. Removes Medicare Advantage rebates and quality bonus payments from the calculation of the low-income subsidy benchmark. Allows Part D plans that bid a nominal amount above the regional low-income subsidy (LIS) benchmark to absorb the cost of the difference between their bid and the LIS benchmark in order to remain a

Requires the Secretary to set geographically adjusted premium rates that cover expected costs. The Deficit Reduction Act of 2005 authorized a demonstration to evaluate arrangements between hospitals and physicians designed to improve the quality and efficiency of care provided to beneficiaries. Replaces the scheduled 21 percent payment reduction to the Medicare physician fee schedule for 2010 with a 0.5 percent positive update. Extends a floor on geographic adjustments to the work portion of the fee schedule through the end of 2010, with the effect of increasing practitioner fees in rural areas. Extension of exceptions process for Medicare therapy caps. Extension of payment for technical component of certain physician pathology services. Allows participants to form a private purchasing council to enter into collective purchasing arrangements for items and services, but which may not set provider payment rates. Requires the Secretary to offer a Community Health Insurance Option as a qualified health plan through Exchanges. Restores payment for dual-energy x-ray absorptiometry (DXA) services furnished during 20 to 70 percent of the Medicare rate paid in 2006. The Secretary shall analyze data collected to detect and monitor trends in health disparities and disseminate this information to the relevant Federal agencies. Establishes a grant program to improve health professionals’ understanding and ability to assess and appropriately treat pain. This law directed the Secretary to initiate a demonstration project to develop a comprehensive and systematic model for reducing childhood obesity. The Secretary will consider whether such programs are effective in achieving their stated goals and evaluate their effect on the health and productivity of the Federal workforce. Prohibits government representatives from serving on the board of directors of participants or the council. Allows States to enact a law to opt out of offering the option. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities. Extension of physician fee schedule mental health add-on. Permitting physician assistants to order post-hospital extended care services. Exemption of certain pharmacies from accreditation requirements. Part B special enrollment period for disabled TRICARE beneficiaries. This section appropriates million for the childhood obesity demonstration project and adjusts the demonstration time period to fiscal years 2010 through 2014. Health insurance companies will be required to refund each enrollee by the amount by which premium revenue expended by the health insurer for non-claims costs exceeds 20 percent in the group market and 25 percent in the individual market. Requires States to make recommendations to their Exchanges about whether health insurance issuers should be excluded from participation in the Exchanges based on unjustified premium increases. Ensures premium rate limits for the newly insured population. Establishes a temporary reinsurance program to provide reimbursement to participating employment-based plans for part of the cost of providing health benefits to retirees (age 55-64) and their families. The part of subtitle C contains amendments to the Public Health Service Act of 1944. Develop a rating system for qualified health plans and a model template for an Exchange’s Internet portal. Reauthorizes demonstration programs to provide patient navigator services within communities to assist patients overcome barriers to health services. The Council will establish a national prevention and health promotion strategy and develop interagency working relationships to implement the strategy. The goal of the Investment Fund is to provide an expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. The goal of the campaign is to raise awareness of activities to promote health and prevent disease across the lifespan. Awards scholarships to mid-career public and allied health professionals employed in public and allied health positions at the Federal, State, tribal, or local level to receive additional training in public or allied health fields. Health insurance companies will be required to report publicly the percentage of total premium revenue that is expended on clinical services, and quality rather than administrative costs. Health insurers will be required to implement an effective process for appeals of coverage determinations and claims. Provides million in funding and is effective upon the date of enactment of the bill. For plan years beginning in 2010, the Secretary and States will establish a process for the annual review of increases in premiums for health insurance coverage. Except for sections 10 (effective upon the date of enactment of this Act), this subtitle shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act. Enacts a temporary insurance program with financial assistance for those who have been uninsured for several months and have a pre-existing condition. Defines a State as one of the 50 States and the District of Columbia. Requires the Secretary to: Establish certification criteria for qualified health plans, requiring such plans to meet marketing requirements, ensure a sufficient choice of providers, include essential community providers in their networks, be accredited on quality, implement a quality improvement strategy, use a uniform enrollment form, present plan information in a standard format, and provide data on quality measures. The Council shall consist of representatives of Federal agencies that interact with Federal health and safety policy, including the departments of HHS, Agriculture, Education, Labor, Transportation, and others. Establishes a Prevention and Public Health Investment Fund. Expands the efforts of, and improves the coordination between, two task forces which provide recommendations for preventive interventions. The Community Preventive Services Task Force uses a public health perspective to review the evidence of effectiveness of population-based preventive services such as tobacco cessation, increasing physical activity and preventing skin cancer, and develops recommendations for their use. Directs the Secretary to convene a national public/private partnership for the purposes of conducting a national prevention and health promotion outreach and education campaign.

premium LIS plan. Allows the surviving spouse of an LIS-eligible couple to delay LIS redetermination for one year after the death of a spouse. Requires HHS, beginning in 2011, to transmit formulary and coverage determination information to subsidy-eligible beneficiaries who have been automatically reassigned to a new Part D low-income subsidy plan. Provides million for outreach and education activities to State Health Insurance Programs, Administration on Aging, Aging Disability Resource Centers and the National Benefits Outreach and Enrollment. Codifies the current six classes of clinical concern, removes the criteria specified in section 176 of MIPPA that would have been used by HHS to identify protected classes of drugs and gives the Secretary authority to identify classes of clinical concern through rulemaking. Reduces the Part D premium subsidy for beneficiaries with incomes above the Part B income thresholds. Eliminates cost sharing for beneficiaries receiving care under a home and community-based waiver program who would otherwise require institutional care. Requires Part D plans to develop drug dispensing techniques to reduce prescription drug waste in long-term care facilities. Requires the Secretary to develop and maintain a plan complaint system to handle complaints regarding Medicare Advantage and Part D plans or their sponsors. Requires Part D plans to use a single, uniform exceptions and appeals process. Requires the OIG to conduct a study comparing prescription drug prices paid under the Medicare Part D program to those paid under State Medicaid programs. Allows drugs provided to beneficiaries by AIDS Drug Assistance Programs or the Indian Health Service to count toward the annual out-of-pocket threshold. The Board would be prohibited from making proposals that ration care, raise taxes or Part B premiums, or change Medicare benefit, eligibility, or cost-sharing standards. Builds on the Center for Quality Improvement and Patient Safety of the Agency for Healthcare Research and Quality (AHRQ) to support research, technical assistance and process implementation grants. Grants or contracts to establish community health teams to support the patient-centered medical home. Grants to implement medication management services in treatment of chronic disease. Establishes a program at HHS for the development, testing, and disseminating of educational tools to help patients, caregivers, and authorized representatives understand their treatment options. Requires the Food and Drug Administration (FDA) to evaluate and determine if the use of drug fact boxes which would clearly communicate drug risks and benefits and support clinician and patient decision making in advertising and other forms of communication for prescription medications is warranted. Establishes a program at AHRQ to give grants to academic institutions to develop and implement academic curricula that integrate quality improvement and patient safety into health professionals’ clinical education. Each State would be required to design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services. The personalized prevention plan would take into account the findings of the health risk assessment and include elements such as: a five- to ten-year screening schedule; a list of identified risk factors and conditions and a strategy to address them; health advice and referral to education and preventive counseling or community-based interventions to address modifiable risk factors such as physical activity, smoking, and nutrition. This section would waive beneficiary coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. The Secretary will also conduct a provider and beneficiary outreach program regarding covered preventive services. Improving access to preventive services for eligible adults in Medicaid. Increases loan amounts and updates the years for nursing schools to establish and maintain student loan funds.

Requires the Secretary to set geographically adjusted premium rates that cover expected costs. The Deficit Reduction Act of 2005 authorized a demonstration to evaluate arrangements between hospitals and physicians designed to improve the quality and efficiency of care provided to beneficiaries. Replaces the scheduled 21 percent payment reduction to the Medicare physician fee schedule for 2010 with a 0.5 percent positive update. Extends a floor on geographic adjustments to the work portion of the fee schedule through the end of 2010, with the effect of increasing practitioner fees in rural areas. Extension of exceptions process for Medicare therapy caps. Extension of payment for technical component of certain physician pathology services.

Allows participants to form a private purchasing council to enter into collective purchasing arrangements for items and services, but which may not set provider payment rates. Requires the Secretary to offer a Community Health Insurance Option as a qualified health plan through Exchanges. Restores payment for dual-energy x-ray absorptiometry (DXA) services furnished during 20 to 70 percent of the Medicare rate paid in 2006. The Secretary shall analyze data collected to detect and monitor trends in health disparities and disseminate this information to the relevant Federal agencies. Establishes a grant program to improve health professionals’ understanding and ability to assess and appropriately treat pain. This law directed the Secretary to initiate a demonstration project to develop a comprehensive and systematic model for reducing childhood obesity. The Secretary will consider whether such programs are effective in achieving their stated goals and evaluate their effect on the health and productivity of the Federal workforce.

Prohibits government representatives from serving on the board of directors of participants or the council. Allows States to enact a law to opt out of offering the option. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities. Extension of physician fee schedule mental health add-on. Permitting physician assistants to order post-hospital extended care services. Exemption of certain pharmacies from accreditation requirements. Part B special enrollment period for disabled TRICARE beneficiaries. This section appropriates million for the childhood obesity demonstration project and adjusts the demonstration time period to fiscal years 2010 through 2014.

Health insurance companies will be required to refund each enrollee by the amount by which premium revenue expended by the health insurer for non-claims costs exceeds 20 percent in the group market and 25 percent in the individual market. Requires States to make recommendations to their Exchanges about whether health insurance issuers should be excluded from participation in the Exchanges based on unjustified premium increases. Ensures premium rate limits for the newly insured population. Establishes a temporary reinsurance program to provide reimbursement to participating employment-based plans for part of the cost of providing health benefits to retirees (age 55-64) and their families. The part of subtitle C contains amendments to the Public Health Service Act of 1944. Develop a rating system for qualified health plans and a model template for an Exchange’s Internet portal. Reauthorizes demonstration programs to provide patient navigator services within communities to assist patients overcome barriers to health services. The Council will establish a national prevention and health promotion strategy and develop interagency working relationships to implement the strategy. The goal of the Investment Fund is to provide an expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. The goal of the campaign is to raise awareness of activities to promote health and prevent disease across the lifespan. Awards scholarships to mid-career public and allied health professionals employed in public and allied health positions at the Federal, State, tribal, or local level to receive additional training in public or allied health fields.

Health insurance companies will be required to report publicly the percentage of total premium revenue that is expended on clinical services, and quality rather than administrative costs. Health insurers will be required to implement an effective process for appeals of coverage determinations and claims. Provides million in funding and is effective upon the date of enactment of the bill. For plan years beginning in 2010, the Secretary and States will establish a process for the annual review of increases in premiums for health insurance coverage. Except for sections 10 (effective upon the date of enactment of this Act), this subtitle shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act. Enacts a temporary insurance program with financial assistance for those who have been uninsured for several months and have a pre-existing condition. Defines a State as one of the 50 States and the District of Columbia. Requires the Secretary to: Establish certification criteria for qualified health plans, requiring such plans to meet marketing requirements, ensure a sufficient choice of providers, include essential community providers in their networks, be accredited on quality, implement a quality improvement strategy, use a uniform enrollment form, present plan information in a standard format, and provide data on quality measures. The Council shall consist of representatives of Federal agencies that interact with Federal health and safety policy, including the departments of HHS, Agriculture, Education, Labor, Transportation, and others. Establishes a Prevention and Public Health Investment Fund. Expands the efforts of, and improves the coordination between, two task forces which provide recommendations for preventive interventions. The Community Preventive Services Task Force uses a public health perspective to review the evidence of effectiveness of population-based preventive services such as tobacco cessation, increasing physical activity and preventing skin cancer, and develops recommendations for their use. Directs the Secretary to convene a national public/private partnership for the purposes of conducting a national prevention and health promotion outreach and education campaign.

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The following summary of the provisions in the Patient Protection and Affordable Care Act is based on PPACA summaries from gov and dpc.and is fact checked for accuracy against the law itself, the Patient Protection and Affordable Care Act HR390. Prohibits all plans from rescinding coverage except in instances of fraud or misrepresentation. Requires Exchanges to award grants to Navigators that educate the public about qualified health plans, distribute information on enrollment and tax credits, facilitate enrollment, and provide referrals on grievances, complaints, or questions. Requires insurers to pool the risk of all enrollees in all plans (except grandfathered plans) in each market, regardless of whether plans are offered through Exchanges. Requires Exchanges to keep an accurate accounting of all expenditures and submit annual accounting reports to the Secretary. Creates performance bonus payments based on a plan’s level of care coordination and care management and achievement on quality rankings. Prohibits Medicare Advantage plans from charging beneficiaries cost sharing for covered services that is greater than what is charged under the traditional fee-for-service program. Application of coding intensity adjustment during MA payment transition. Simplification of annual beneficiary election periods. Provides extra time for CMS, Medicare Advantage plans and prescription drug plans to process enrollment paperwork during annual enrollment periods and eliminates a duplicative open enrollment period for Medicare Advantage plans. Extension for specialized MA plans for special needs individuals. Requires the HHS Secretary to support emergency medicine research, including pediatric emergency medical research. Such services would include diagnostic, therapy and counseling services, and prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration for cessation of tobacco use by pregnant women. Incentives for prevention of chronic diseases in Medicaid. Authorizes States to purchase adult vaccines under CDC contracts. Codifies the existing national center and establishes several regional centers for health workforce analysis to collect, analyze, and report data related to Title VII (of the Public Health Service Act) primary care workforce programs.

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