2012 PPACA Implementation Highlights

The implementation train for the Patient Protection and Affordable Care Act (PPACA) continues to pick- up speed with a number of important implementation dates in 2012. 

Keeping up with the pace can be challenging. To assist, the U.S. Department of Health and Human Services (HHS) offers  a website that helps track the major reform efforts, titled “What’s Changing and When.” Also useful is an online article posted by the White House that gives a year-by-year overview of the PPACA timeline.    

Here’s a snapshot of some 2012 milestones:

Accountable Care Organizations

Accountable Care Organizations (ACOs) are going live this month. As quoted on the HHS website:

The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” In these groups, doctors can better coordinate patient care and improve the quality, help prevent disease and illness, and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.

For additional information about ACOs, see BenefitMall’s recent blogs on these integrated systems of care.

External Review

Effective January 1 this year, health plans and insurers issuing new policies and offering “non-grandfathered” coverage must now provide an expanded claims and appeals process that meets government regulations, including the new external review requirements. For background on PPACA’s external review requirements, see BenefitMall’s recent blogs on the subject. 

Tracking Population Disparities

Beginning in March, federal health programs will be required to collect and report information on patients’ race, ethnicity, sex, primary language and disability status. The requirement, contained in Section 4302 of PPACA, is aimed at illuminating health disparities among racial and ethnic minorities and finding effective ways to reduce them. Kathleen Sebelius, Secretary of HHS, said in a press statement, “…these new standards…are providing a set of powerful tools to help us achieve our vision of a nation free of disparities in health and health care.”

HHS also will implement its Action Plan to Reduce Racial and Ethnic Health Disparities in conjunction with the National Partnership for Action’s (NPA) National Stakeholder Strategy for Achieving Health Equity. NPA, a subsection of HHS’ Office of Minority Health, will implement the new standards as part of its goal to “increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders.”

Summary of Benefits and Coverage

In an August 2011 press release, the federal government announced a new initiative authorized under PPACA to help consumers better understand their health coverage and determine the best health insurance options for themselves and their families. The new rule will require group health plans and health issuers to provide a uniform summary of benefits and coverage to interested parties. 

The goal of the requirement, found in Section 2715, is to provide a tool for the public to use in comparing services, costs, and provisions among different health care plans. Secretary of Labor Hilda L. Solis said the summary would, “…help workers quickly and easily compare different coverage options in order to make more informed decisions.” The document would consist not only of a summary of benefits and coverage, but also would include a glossary of pertinent terms and “coverage examples” that would demonstrate the costs paid by the program in the case of pregnancy, diabetes or a diagnosis of breast cancer.

Rumor has it the March 2012 implementation date for uniform summary of benefits and coverage might be delayed. 

Reducing Paperwork and Administrative Costs

In October, HHS will attempt to increase the efficiency of health care. The website notes:

Health care remains one of the few industries that relies on paper records. The new law institutes a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve the quality of care.Reducing Paperwork and Administrative Costs Reducing Paperwork and Administrative Costs

Linking Payments to Quality Outcomes

In October, PPACA will require the establishment of a hospital Value-Based Purchasing program (VBP). As highlighted in an HHS press release, the Medicare Program will be offering financial incentives to hospitals to improve the quality of care. HHS notes, “This program marks the beginning of an historic change in how Medicare pays health care providers and facilities—for the first time, hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.” Hospital performance will be publicly reported and include with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care.

More to Come

Without a doubt, other PPACA elements will be implemented in 2012.  Stay tuned for additional details. 

We have covered many of the related issues that involve PPACA and will continue to follow these issues for you. Please visit www.HealthcareExchange.com for those and other blog posts, polls, surveys and numerous resources and visit www.benefitmall.com to view past Legislative Alerts.