Hospitals

Expands the RAC program to include audits of Medicaid and Medicare Parts C and D.

Eliminates the exception for physician-owned hospitals under the Stark law. Grandfathers in providers with Medicare agreements in place before Dec. 31, 2010.

Extends Section 508 hospital reclassification until Sept. 30, 2010.

*Expands 340B drug discounts to outpatient drugs for cancer hospitals, children’s hospitals, CAHs, SCHs and rural referral centers.

Establishes grants for clinics and hospitals to promote positive health behaviors in underserved areas.

Requires nonprofit hospitals to conduct periodic community-needs assessments.

Extends rural outpatient hold harmless payments.

Reduces Medicare inpatient, outpatient, IRF and psychiatric hospital payments by 0.25 percent and LTCH payments by 0.5 percent by April 1, 2010.

Insurance

Prohibits all new health plans from denying children coverage based on pre-existing conditions.

Eliminates co-payments for preventive services and exempts preventive services from Medicare deductibles.

Provides tax credit of up to 35 percent of premiums to small businesses.

Requires new health plans to cover preventive services.

Bans rescission practices and lifetime limits.

Coverage

Restricts use of annual limits on coverage.

Provides a $250 rebate to Medicare beneficiaries who hit the “donut hole.”

Extends coverage to those up to age 26 through parents’ insurance.

Establishes interim high-risk pool for the uninsured; provides temporary mechanisms to provide access to individuals with pre-existing conditions and for non-Medicare eligible retirees over 55 until new insurance exchange starts in 2014.

Establishes health plan for companies with early retirees.

Other/Workforce

Allows the counting of resident time in non-provider settings for Graduate Medical Education beginning July 1, 2010.

Expands health professional loan repayment programs.

Enhances elimination of Medicare fraud efforts.

Establishes a National Health Care Workforce Commission to provide recommendations to Congress on aligning healthcare workforce resources.

Delivery System

Establishes a Patient-Centered Outcomes Research Institute to conduct comparative effectiveness research.

Hospitals

*Adjusts Medicare payments according to study on Outpatient Prospective Payment System for PPS-exempt cancer hospitals.

Provides $400 million for payments to hospitals located in counties that rank in the lowest quartile for age, sex and race adjusted per enrollee for Medicare Parts A and B (geographic variation).

Requires HHS secretary to submit recommendations for reforming Medicare Area Wage Index.

Begins implementation of RUGs-IV payment changes for SNFs.

Prevents Medicaid payments to be used to pay for HACs.

Extends reasonable cost payment for clinical diagnostic lab services for rural hospitals with fewer than 50 beds to July 1, 2011.

Reduces Medicare inpatient, outpatient, SNF, IRF, psychiatric hospital, dialysis and LTCH payments by a “productivity adjustment” of .1 percent.

Insurance

Requires all health plans to report annually on the share of premiums spent on medical care and rebate beneficiaries for excessive medical loss ratios.

Coverage

Expands Medicaid eligibility to all people under 133 percent of FPL; voluntary until 2014.

Establishes voluntary payroll deduction long-term care insurance program.

Requires states to establish health insurance exchanges through individuals. Small businesses can purchase private health insurance coverage through: a federal employee benefit plan-like, multi-state plan; a consumer-operated and oriented plans to foster non-profits, member-run cooperatives.

Other/Workforce

Establishes a 10-percent bonus payment to primary care physicians and general surgeons (continues through 2016)

Redistributes unused residency slots, 75 percent of which must be used for general surgery or primary-care slots, by July 1, 2011.

Establishes a $33 billion assessment on brand-name pharmaceuticals.

Provides scholarship and loan repayment funds for primary-care practitioners in National Health Services Corps area.

Delivery System

Establishes the Community Care Transitions Program for high-risk Medicare beneficiaries.

Creates a Center for Medicare and Medicaid Innovation within CMS to test innovative payment and service-delivery models that improve quality and reduce expenditures.

Gainsharing demonstration project expires, but $1.6 million in funds will be available until 2014.

Hospitals

Reduces Medicare inpatient, outpatient, SNF, IRF, psychiatric hospital, dialysis and LTCH payments by a “productivity adjustment” of  0.1 percent.

Requires HHS secretary to implement a “national quality assurance and performance improvement program” for SNFs and home health.

Extends FLEX programs through 2012.

Extends Medicare Dependent Hospital classification through Sept. 30, 2012.

Other/Workforce

Increases funds for nursing and allied health professionals’ loan repayment programs.

Delivery System

Reduces payments for hospitals with “higher-than-expected” readmissions rates for specific conditions; maximum reduction is 1 percent.

Establishes a Medicare VBP program that adjusts 1 percent of payment according to data collection and reporting on five medical conditions.

Begins voluntary ACO payment program.

Requires HHS secretary to give additional Medicare funds to lowest-cost counties in the country.

Hospitals

Reduces Medicare inpatient, outpatient, SNF, IRF, psychiatric hospital, dialysis and LTCH payments by a “productivity adjustment” of  0.3 percent.

Establishes quality and efficiency measures for PPS-exempt cancer hospitals to report. Noncompliance results in a reduction in the market basket update.

Imposes financial penalties on hospitals for “excess” readmissions when compared to “expected” levels; excludes critical access hospitals and post-acute care providers.

Establishes a pay-for-reporting program for IRFs, LTCHS, hospices and psychiatric hospitals. Noncompliance results in a 2-percent reduction to market basket updates.

Insurance

Begins Nonprofit Consumer Operated and Oriented Plans (Co-ops).

Other/Workforce

Establishes a 2.3-percent excise tax on medical devices.

Delivery System

Simplifies administrative burdens by standardizing electronic exchange of health information.

Begins voluntary bundled payment five-year pilot program. Includes payment for 10 conditions; if successful, may be expanded after 2015.

Expands Medicare VBP program to include more conditions and efficiency measures, including spending per beneficiary. Adjusts payments by 1.25 percent. Includes an appeals process.

Hospitals

Reduces inpatient, outpatient, IRF, LTCH and psychiatric hospital payments by 0.2 percent.

Begins reduction in Medicare DSH payments by $22.1 billion. Reductions are tied to coverage.

Begins reduction in Medicaid DSH payments by $14 billion. Reductions are not directly triggered by coverage targets. Directs secretary to develop methodology for reducing federal DSH allotments to states.

Reduces market basket by an estimate of productivity, with added reductions of  0.3 percent.

Insurance

*Requires standard-of-care coverage for all life-threatening disease clinical trials.

Begins Health Benefits Exchanges.

Requires an assessment of $67 billion on health insurers.

Bans coverage refusal based on pre-existing conditions for all people, and bans lifetime and annual limits.

Coverage

Requires states to cover all former foster children up to age 26 through Medicaid.

Requires states to cover individuals up to 133 percent of federal poverty level; 100 percent federal financing thru 2017.

Provides tax credit up to 50 percent of premiums to small businesses.

Provides 100 percent federal funding for costs associated for Medicaid “newly eligibles” through 2016.

Begins individual mandate for health insurance.

Other/Workforce

Grants for clinics and hospitals to promote positive health behaviors in underserved areas expire.

Delivery System

Expands readmission policy to include more conditions. Maximum reduction in payments to hospitals with higher-than-expected readmissions rate increases to 3 percent.

Requires all eligible professionals to participate in the Physician Quality Reporting Initiative. Provides a 0.5 percent bonus to those reporting properly and deducts funds from those who use substantially more resources than their peers.

Allows Medicare VBP program to adjust payments by 1.5 percent.

Provides hospitals in the top 25^th percentile of certain HAC rates with a 1-percent payment reduction.

Hospitals

Reduces Medicare inpatient, outpatient, IRF, LTCH and psychiatric hospital payments by 0.2 percent (and 2016).

Adds a 1-percent penalty to hospitals in top quartile of rates of HACs; reductions of $1.5 billion over 10 years.

Extends Rural Community Hospital Demonstration Project through 2015.

Coverage

Provides 100 percent federal funding for costs associated for Medicaid “newly eligibles” through 2016.

Other/Workforce

Establishes Independent Payment Advisory Board to submit recommendations to Congress on reducing Medicare spending. Hospitals receiving productivity adjustments are exempt from board proposals through 2019. CAHs are not exempt.

Delivery System

Allows Medicare VBP program to adjust payments by 1.75 percent.

Expands bundled payment program according to HHS secretary’s plan.

Hospitals

Reduces Medicare inpatient, outpatient, IRF, LTCH and psychiatric hospital payments by 0.75 percent.

Coverage

Provides 100 percent federal funding for costs associated for Medicaid “newly eligibles” through 2016.

Provides states with an FMAP increase of 23 percent to accommodate transition from CHIP to the exchanges. Increase occurs through 2019.

Delivery System

Allows Medicare VBP program to adjust payments by 1.75 percent.

Hospitals

Reduces Medicare inpatient, outpatient, IRF, LTCH and psychiatric hospital payments by 0.75 percent.

Insurance

Allows employers with more than 100 employees to enter the exchanges at the discretion of the state.

Coverage

Reduces federal funding for costs associated with Medicaid “newly eligibles” to 95 percent of costs.

Delivery System

Allows HHS secretary to expand VBP pilot program for IRFs, LTCHs, psychiatric hospitals, PPS-exempt hospitals and hospices.

Hospitals

Reduces Medicare inpatient, outpatient, IRF, LTCH and psychiatric hospital payments by 0.75 percent.

Coverage

Reduces federal funding for costs associated with Medicaid “newly eligibles” to 94 percent.

Hospitals

Reduces Medicare inpatient, outpatient, IRF, LTCH and psychiatric hospital payments by 0.75 percent.

Coverage

Reduces federal funding for costs associated for “newly eligibles” in Medicaid to 90 percent.