Law, Explanation and Analysis of the Patient Protection and Affordable Care Act: Including Reconciliation Act Impact, Volume 1

Front Cover
Wolters Kluwer, Jan 1, 2010 - Law - 1183 pages
"This book contains an editorially enhanced version of the Patient Protection and Affordable Care Act that integrates in place changeds made to it by the Reconciliation Act of 2010. ... A special website, http://www.mediregs.com/cchhealthreform, has been created to expand your access to key legislative materials"--Facing t.p.
 

Contents

105 No Lifetime or Annual Coverage Limits 107 Prohibition on Rescission 109 Preventive Health Services Coverage 111 Extension of Dependent C...
37
345 Small Employer Health Insurance Credit 350 Free Choice Vouchers in Employer Plans 355 Free Choice Vouchers Employer Tax Credit CHAPT...
39
MEDICAID CHILDRENS HEALTH INSURANCE PROGRAM MEDICAID COVERAGE AND ELIGIBILITY 505 New Groups Required to be Cov...
40
543 Medicaid Prescription Drug Rebates 545 Elimination of Medicaid Exclusion of Certain Drugs 547 Adequate Pharmacy Reimbursement MEDIC...
41
564 Qualified Plans and CHIP 565 Presumptive Eligibility Determinations by Hospitals
42
743 Creation of Accountable Care Organizations Under the Medicare Shared Savings Program 745 National Pilot Program on Payment Bundling 74...
43
820 New Authority for Physician Assistants
44
1015 Improvements to Medicare DSH Payments 1017 Skilled Nursing Facility Prospective Payment System 1020 Misvalued Codes Under the Physic...
45
1485 Congenital Heart Disease Programs
676
1490 Reauthorization of the Public Access Defibrillation Program
677
1495 BreastHealth Awareness in Young Women
678
HEALTHCARE WORKFORCE IMPROVEMENTS INNOVATIONS 1505 National Health Care Workforce Commission 1507 State Health Care Wor...
681
1594 Reauthorization of the Wakefield Emergency Medical Services for Children Program
682
1595 CoLocating Primary and Specialty Care Services 1596 Creation of a Key National Indicators System 1597 Grants to Fund Programs for Medica...
683
1517 Pediatric Specialty Loan Repayment Program
698
1519 Public Health Workforce Loan Repayment Program
702

1035 Improvement of Hospital Wage Index System
46
113 New Uniform Standards for Health Plan Summary of Benefits and Coverage 115 Additional Information Regarding Transparency in Coverage 1...
55
195 Health Plan Market Study
56
COVERAGE CHOICES QUALIFIED HEALTH PLANS
68
133 Review of Premium Increases
83
IMMEDIATE ACTIONS TO PRESERVE AND EXPAND COVERAGE 135 Insurance Access for Individuals With PreExisting Conditions
85
137 Reinsurance for Early Retirees
89
140 Internet Portal for Health Coverage Information
90
145 Administrative Simplification for Electronic Health Care Transactions
92
ADDITIONAL REFORMS 150 Insurance Premium Rates Limitations
98
155 Guaranteed Availability and Renewal
100
165 Preexisting Condition Exclusion
107
170 Prohibiting Discrimination Based on Health Status
108
175 State Prohibitions On Discrimination Against Health Care Providers
114
180 Comprehensive Health Insurance Coverage
115
181 Prohibition on Excessive Waiting Periods
116
183 Coverage For Individuals Participating in Approved Clinical Trials
117
185 Grandfathered Plans in the Individual and Group Health Markets
119
190 Annual Report on SelfInsured Plans
122
205 Contents of Essential Health Benefits Package 210 Special Rules Relating to Abortion Coverage HEALTH BENEFIT EXCHANGES 215 Establis...
127
235 Nonprofit Health Insurance Issuers
154
240 Exempt Status Available to Nonprofit Health Insurance Issuers
158
245 Level Playing Field for Private Insurance Issuers
159
STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS 250 State Basic Health Programs for LowIncome Individuals Not Eligible fo...
161
255 State Waiver of Requirements Relating to Qualified Health Plans
164
260 Interstate Health Care Choice Compacts
166
265 MultiState Plans
168
REINSURANCE AND RISK ADJUSTMENT 270 Transitional Reinsurance Program for Individual Markets
171
275 Transitional Risk Corridors for Plans in Individual and Small Group Markets
175
280 Risk Adjustment for Plans in Individual and Small Group Markets
177
AFFORDABILITY OF COVERAGE PREMIUM CREDITS AND COSTSHARING REDUCTIONS 305 Health Insurance Premium Assistance Refunda...
179
310 CostSharing Reductions
191
517 Recision of Appropriations to Medicaid Improvement Fund EXPANSION OF MEDICAID SERVICES 519 Medicaid Coverage of FreeStanding ...
257
523 New Optional Coverage for Family Planning
275
525 Definition of Medical Assistance OPTIONS FOR STATES TO PROVIDE LONGTERM SERVICES AND SUPPORTS 530 Community First Choi...
278
315 Procedures for Determining Eligibility
315
320 Advance Determinations and Payments
320
566 Extension of Childrens Health Insurance Program
321
OTHER PROVISIONS 567 Disproportionate Share Hospital Payments
323
325 Streamlined Health Program Enrollment Procedures
325
330 Disclosures to Carry Out Eligibility Requirements for Certain Programs
330
335 Premium Assistance Tax Credit and CostSharing Reduction Payments Disregarded for Federal Assistance Programs
335
340 Application of Geographic Variations in Determining Federal Poverty
340
MATERNAL AND CHILD HEALTH SERVICES MATERNAL AND CHILD HEALTH SERVICES 605 Maternal Infant and Early Childhood Home ...
341
620 Restoration of Funding for Abstinence Education
350
625 Foster Care Transition Planning
352
SUPPORT FOR PREGNANT AND PARENTING TEENS AND WOMEN 630 Pregnancy Assistance Fund
353
635 Permissible Uses of Funds
354
HEALTH CARE QUALITY IMPROVEMENT QUALITY ADJUSTED PAYMENTS 705 Hospital ValueBased Purchasing Program 707 Critical Acce...
357
751 CommunityBased Care Transitions Program 753 Gainsharing Demonstration Program Extended Through 2011
358
Level
369
717 Quality Reporting for Hospice Programs LTC Inpatient Rehabilitation and Psychiatric Hospitals
374
719 Quality Reporting for PPSExempt Cancer Hospitals
375
725 Adjustment to Hospital Payments for Hospital Acquired Conditions
376
NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY 727 National Strategy Defined
378
729 Interagency Working Group on Health Care Quality
380
731 Quality Measure Development
382
733 Quality Measurement and Selection of Efficiency Measures
383
735 Collection of Data for Quality and Resource Measures
385
737 Medicare Data Availability for Performance Measurement Reports
386
739 Modernization of CMS Computer and Data Systems
388
DEVELOPMENT OF NEW PATIENT CARE MODELS 741 New Center for Medicare and Medicaid Innovation to Test New Payment Models
389
761 Regionalized Emergency Care Systems
415
763 Trauma Care Center Grant Programs
420
765 Program to Facilitate Shared Decision Making
421
767 Prescription Drug Summaries
424
769 Demonstration Program to Improve Clinical Education of Health Professionals
427
771 Office of Womens Health
429
773 Patient Navigator Program
431
775 Appropriations
432
777 GAO Study and Report on Causes of Action
433
779 Medicare Coverage for Individuals Exposed to Environmental Health Hazards
434
780 Early Detection Program for Medical Conditions Related to Environmental Health Hazards
436
781 State Grants to Providers
437
783 Procedural Requirements for Approval of Medicaid and CHIP Demonstration Projects
438
790 GAO Study on Medicare Beneficiary Access to Dialysis Services
440
795 Health Care Facility Infrastructure Funding
441
797 Appropriations for the Community Health Center Fund
442
MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS PHYSICIAN FEE SCHEDULE 805 Extension of the Work Geographic Index ...
445
835 Part B Special Enrollment Period and Waiver of Premium Increase for Disabled TRICARE Beneficiaries
452
840 Improved Access for Nurse Midwife Services
454
845 Medical Coverage for Individuals Exposed to Environmental Health Hazards
455
OTHER PAYMENT AND BILLING PROVISIONS 850 Extension of Therapy Caps Exceptions Process
456
855 Rural Ambulance Addons Extension
457
860 Extension of Payments for LongTerm Care Hospital Services and of Moratorium on the Establishment of Certain Hospitals and Facilities
458
865 Payment for Bone Density Tests
459
870 Revision to the Medicare Improvement Fund
460
875 Complex Diagnostic Laboratory Tests
461
877 Payment for Qualifying Hospitals
462
905 Additional Outpatient Reimbursement for Rural Hospitals 910 Rural Laboratory Test Payment Increase Reinstatement 915 Rural Community Hos...
465
917 Community Mental Health Centers Providing Partial Hospitalization Services
469
920 MedicareDependent Hospital Program Extension
471
925 LowVolume Hospital Temporary Payment Improvements
472
930 Rural Demonstration Projects Expanded
473
935 MedPAC Study on Medicare Payments in Rural Areas
474
940 Critical Access Hospital Technical Corrections
475
945 Rural Hospital Flexibility Program Changes
476
950 Frontier States Wage Index and Physician Practice Expense Index Floors
477
MEDICARE PAYMENT ACCURACY IMPROVEMENTS 1005 Home Health Payments 1010 Hospice Care Payment Reforms
481
1065 Protecting Home Health Benefits
501
1070 Comparative Cost Adjustment Program
503
PROVISIONS RELATING TO MEDICARE PART C
505
1140 PACE Programs
524
BENEFIT PROTECTIONS AND OTHER IMPROVEMENTS 1145 Limitation on MA Beneficiary Cost Sharing for Some Essential Services
525
1150 Coding Intensity Adjustment for Medicare Advantage
527
1155 Open Enrollment Periods for MA and Part D Plans
528
1160 Special Needs Plans Enrollment Extension
529
1165 Extension of Reasonable Cost Contracts
531
Service Area Waiver for MA Private FeeForService Plans
532
533 Removal of Barriers to Home and CommunityBased Services
533
534 Optional Coverage of HigherIncome Beneficiaries and Reports
534
1185 Development of New Standards for Medigap Plans
535
1195 Medicare Advantage Plans Medical Loss Ratios
536
DRUG COVERAGE
539
1235 Improved Information for Subsidy Eligible Individuals Reassigned
554
1270 Uniform Exceptions and Appeals Process for PDPs and MAPD Plans
567
573 Special Rules Applying to Indians
573
575 Reimbursement for Part B Services Furnished by Indian Hospitals and Clinics
575
577 Medicaid Matching Funds for Assistance to Newly Eligible
577
580 Increased Matching Funds for CHIP
580
585 Technical Corrections to CHIPRA
585
Services
588
1360 Productivity Adjustment to Rates for Laboratory Services
589
590 LongTerm Care Balancing Incentive
590
1375 Productivity Adjustment to Rates for Miscellaneous Services
591
OTHER SUSTAINABILITY METHODS 1380 Adjustment to Part B Premium Calculation
592
597 Demonstration on Access to Affordable Care
597
1385 Independent Medicare Advisory Board
600
1390 Protecting and Improving Guaranteed Medicare Benefits
601
1395 No Cuts in Guaranteed Benefits
603
DISEASE PREVENTION AND WELLNESS MODERNIZING DISEASE PREVENTION AND PUBLIC HEALTH SYSTEM 1405 National Public H...
605
SUPPORT FOR PREVENTION AND PUBLIC HEALTH INNOVATION 1445 Research Public Health Services and Systems 1447 Data Collection to ...
606
INCREASING ACCESS TO CLINICAL PREVENTIVE SERVICES
617
1413 SchoolBased Health Centers
618
1415 Oral Healthcare and Prevention Activities
621
1417 Medicare Coverage of Annual Wellness Examination as Part of Personalized Prevention Plan
625
1419 Removal of Barriers to Medicare Preventive Services
627
1421 EvidenceBased Coverage of Preventive Services in Medicare
628
1423 Access to Preventive Services for Adults
630
1425 Coverage of Drugs for Smoking Cessation
631
1427 Incentive Payments for Prevention of Chronic Diseases
633
CREATING HEALTHIER COMMUNITIES 1429 Community Transformation Grants
635
1431 Healthy Aging Programs
639
1433 Medical Diagnostic Equipment Standards
643
1435 Immunizations
645
1437 Calorie and Nutrition Labeling of Standard Menu Items
648
1439 Individualized Wellness Plan Pilot Program
651
1475 Cures Acceleration Network
672
1480 Centers of Excellence for Depression
674
1521 Allied Health Loan Forgiveness Program
704
1523 Grants for State and Local MidCareer Training Programs
706
1525 National Health Service Corps Funding
707
1527 Grants to NurseManaged Health Clinics
709
1529 Elimination of Cap on Public Health Service Regular Corps Commissioned Officers
710
1531 Public Health Service Ready Reserve Corps
711
EDUCATION AND TRAINING
724
1545 Training Grants for Mental and Behavioral Health Education
729
1547 Cultural Competency Prevention Public Health and Individuals with Disabilities Training
732
1549 Advanced Nursing Education Grants
736
1551 Nurse Education Practice and Retention
739
1553 Loan Repayment and Scholarship Program
740
1555 Nurse Faculty Loan Program
742
1557 Authorization of Appropriations
745
1559 Grants to Promote the Community Health Workforce
746
1561 Fellowship Training in Public Health
748
1563 United States Public Health Sciences Track
749
1565 Demonstration Grants for Family Nurse Practitioner Training Programs
756
SUPPORTING THE EXISTING HEALTH CARE WORKFORCE
759
1567 Centers of Excellence
760
1569 Health Care Professionals Training for Diversity
761
1571 Area Health Education Centers
764
1573 Workforce Diversity Grants
766
1575 Primary Care Extension Program
769
STRENGTHENING PRIMARY CARE AND OTHER WORKFORCE IMPROVEMENTS 1577 Medicare Payment Bonus for Primary Care Practitione...
771
1578 New Prospective Payment System for Federally Qualified Health Centers
772
1579 Unused Resident Positions
774
1581 Counting Resident Time in Nonprovider Settings
776
1583 Counting Resident Time for Scholarly and Other Activities
778
1585 Preservation of Resident Cap Positions from Closed Hospitals
779
1587 Health Professions Workforce Needs Extension of FamilytoFamily Health Information Centers
781
1589 Increasing Teaching Capacity
784
1590 Graduate Nurse Education Demonstration Project
787
IMPROVING ACCESS TO HEALTH CARE SERVICES 1591 Federal Grants for Qualified Health Centers
789
Negotiated Rulemaking
791
1599 Reports
803
PHYSICIAN REFERRALS 1605 Exception to the Medicare Prohibition on Physician Referrals for Hospitals
806
PHYSICIAN OWNERSHIP AND OTHER TRANSPARENCY 1610 Transparency Reporting of Physician Ownership and Investment
811
1615 InOffice Ancillary Services Exception for Certain Imaging Services
815
1620 Prescription Drug Samples
816
1625 Pharmacy Benefit Manager Transparency
818
NURSING HOME TRANSPARENCY 1630 Required Disclosure of Ownership
820
1635 Compliance and Ethics Requirements
822
1640 Nursing Home Compare Website
825
1645 Skilled Nursing Facility Expenditure Reporting
826
1650 Complaint Standardization for Nursing Home Residents
828
1655 Nursing Facility Staffing Information
829
1660 GAO Study on FiveStar Quality Rating System of Nursing Homes
830
1665 Dementia and Abuse Prevention Training
831
ENFORCEMENT 1670 Civil Monetary Penalties for Deficiencies at Nursing Facilities
832
1673 Medicare Prepayment Review
834
1675 Independent Monitor Pilot Program
835
1680 Facility Closure Notifications
836
1685 Nursing Home Demonstration Project on Information Technology Usage
838
1690 Fraud Enforcement Augmentation
839
1693 Medical Tort Litigation Alternatives Demonstration Program
841
1695 Extension of Medical Malpractice Coverage to Free Clinics Employees
844
PATIENTCENTERED OUTCOMES RESEARCH 1705 PatientCentered Outcomes Research Trust Fund Established and Funded
849
1710 Federal Coordinating Council
854
MEDICARE MEDICAID AND CHIP PROGRAM INTEGRITY MEDICARE AND MEDICAID 1805 Provider Screening and Enrollment Requireme...
855
1813 Federal Matching Funds Exclusions and Penalties
864
1815 Subpoena Authority and Specific Intent Requirement
866
1817 Surety Bond Requirements
868
1821 Payment Suspension During Fraud Investigation
869
1823 Increased Funding for Fraud and Abuse Enforcement Activities
870
1825 Medicare and Medicaid Integrity Program Contractor Reporting
872
1827 Expanded Application of Hardship Waivers for OIG Exclusions to Beneficiaries of Any Federal Health Care Program
874
1831 Elimination of Duplication Between the Healthcare Integrity and Protection Data Bank and the National Practitioners Data Bank
875
1833 Reduction of Period for Submission of Medicare Claims
880
1835 Requirements for Physicians Who Order DME or Home Health Services
881
1837 Physician and Supplier Documentation of Referrals to Programs at High Risk of Fraud and Abuse
882
1839 Requirement for Certifying Patient Eligibility for Home Health Services or DME under Medicare
885
1841 Penalties for False Statements
887
1843 Physician SelfReferral Disclosure Protocol
889
1845 Adjustments to the Medicare DMEPOS Competitive Acquisition Program
892
1847 Expansion of the RAC Program
894
ADDITIONAL MEDICAID PROVISONS 1850 Exclusion from Medicaid Participation Due to Affiliations
896
1853 Termination of Participation of Medicaid Providers
897
1855 Billing Agents Clearinghouses or Other Alternate Payees Registration Requirements Under Medicaid
898
1857 Requirement to Report Expanded Set of Data Elements Under MMIS
899
1858 Funding for Territories That Establish a Health Benefit Exchange
900
1859 No Medicaid Payment to Entities Outside the United States
901
1861 Extension of Period for Collection of Overpayments Due to Fraud
902
1863 Medicaid Requirements Under the Correct Coding Initiative
904
OTHER PROVISIONS 1865 Prohibition on False Statements Regarding Multiple Employer Welfare Arrangement MEWA Plans
905
1867 Federal Health Care Offense Clarification
906
1869 Development of Model Uniform Report Form
908
1871 Application of State Law to MEWA Plans
909
1873 Administrative Orders Against Distressed MEWA Plans
910
1875 MEWA Plan Registration With Labor Department
911
1880 Permitting Evidentiary Privilege in Confidential Communications
912
ELDER JUSTICE ACT ELDER JUSTICE 1905 Elder Justice Act OTHER PROVISIONS 1910 Option for State Plan under TANF
915
1915 National Training Institute for Surveyors
918
1920 Grants to State Survey Agencies
919
1925 Reporting of Crimes in Federally Funded LongTerm Care Facilities
920
1930 National Nurse Aide Registry
922
ACCESS TO INNOVATIVE MEDICAL THERAPIES BIOLOGICS PRICE COMPETITION AND INNOVATION 2005 Biologics Price Competition ...
923
MORE AFFORDABLE MEDICINES FOR CHILDREN AND UNDERSERVED COMMUNITIES 2025 Expanded Participation in 340B Program for ...
934
2030 Integrity Requirements Under Drug Discount 340B Program
936
2035 GAO Study on Section 340B Program CHAPTER 21 CLASS
940
2105 Community Living Assistance Services and Supports CLASS Program
942
2125 CLASS Program Benefits
948
2130 CLASS Independence Fund
955
2135 CLASS Independence Advisory Council
958
2140 HHS Secretarys Annual Report on CLASS Program
959
2145 Annual Inspector Generals Report on CLASS Program
961
2150 Personal Care Attendants Workforce Provision and Advisory Panel
962
2155 Inclusion of CLASS Program Information in the National Clearinghouse for Long Term Care Information
964
REVENUE PROVISIONS OFFSETS 2205 Excise Tax on High Cost EmployerSponsored Health Coverage 2210 Inclusion of Cost of EmployerSpons...
967
2260 Elimination of Deduction for Federal Subsidies for Certain Retiree Prescription Drug Plans
1000
2265 Itemized Deduction for Medical Expenses
1003
2270 Limitation on Excessive Employee Remuneration
1004
2275 Additional Medicare Tax on Wages and SelfEmployment Income
1006
2277 Modification of Tax Treatment of Certain Health Organizations
1010
2279 Excise Tax on Indoor Tanning Salon Services
1011
OTHER PROVISIONS 2285 Exclusion of Qualified Health Care Benefits of Indian Tribe Members
1012
2287 Simple Cafeteria Plans
1016
2289 Credit for Therapeutic Discovery Projects
1018
2291 Exclusion for Assistance Provided to Participants in State Student Loan Repayment Programs for Certain Health Professionals
1025
2293 Adoption Credit and Adoption Assistance Programs
1027
2295 Medical Benefits for Children Under Age 27
1030
2296 Black Liquor CarveOut for Cellulosic Biofuel Producer Credit
1034
2297 Economic Substance Doctrine
1037
2298 Penalties for Underpayments Attributable to Transactions Lacking Economic Substance
1041
2299 Corporate Estimated Tax Payments
1042
2305 Indian Health Care Improvement Act CHAPTER 24 MISCELLANEOUS PROVISIONS
1046
2405 Government Transparency 2410 Prohibition of Discrimination on Assisted Suicide 2415 Access To Therapies
1055
2420 Freedom Not to Participate in Federal Health Insurance Programs
1058
2425 Equity for certain eligible Black Lung survivors
1059
2430 Nondiscrimination in Health Programs or Activities
1060
2435 Employee Protections
1062
2440 Oversight by HHS Inspector General 2445 Treatment Of Antitrust Laws Hawaii Prepaid Health Care Act and Student Health Insurance
1065
2450 Information Technology and Enrollment in Federal and State Programs
1068
2455 GAO to Study Denial Rates by Health Insurance Issuers
1070
2460 Nonwaiver of Procurement Requirements
1071
2465 Continued Utilization Management Techniques
1073
2470 Impact of PHSA Reforms on ERISA
1074
2475 Impact of PHSA Reforms on Internal Revenue Code
1075
2480 Sense of Senate on Medical Malpractice
1082
2485 Sense of Senate on Fiscal Responsibility
1083
2490 Implementation Funding
1084
2494 Community College and Career Training Program
1085
Medicaid Enrollment
1100
Volume 1
1
Medicaid Childrens Health Insurance Program 605 Chapter 6 Maternal and Child Health Services 705 Chapter 7 Health Care Quality Improvement 8...
3
1533 Primary Care Training and Enhancement
448
1537 Training Opportunities for Direct Care Workers
450
Repealed
973

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