Sunday, March 21, 2010

reading the Health Care legislation

Reading health care legislation. Made some notes on original House bill. Looking for priorities, engineering strategies, ethics milestones. House today is voting on amended Senate reconciliation bill, which I'm reading here.


Indians protected from taxation of previously secured benefits.
Children – under 21 get vision, dental, hearing, medical equipment, etc.
The Mentally Ill
Financial Support and Training for Nurses
Ingenuity Garden
States compete creatively
Funding Rewards for State Solutions
Generic drugs are a medical right
Low-income access and awareness
Prevention and healthy lifestyle
Efficiency and Accountability
Encourage diversity in health profession
Encourage diversity in health training profession
Health Jobs for Veterans
Anti-trust revisions for insurers
Access for the Disabled
Research- and technology-driven answers to persistent systemic questions
Systemic cost reduction strategies
Rare diseases and nontraditional patients protected
Strategic expansion of Medicare and Medicaid to protect the modern vulnerable
Non-rich families
Individual empowerment, access, accountability
Expanded hardship sympathy waivers
Documentation and smart databasing
Legal obligation to study effectiveness data and make recommendations
Self-monitoring and disclosure incentives
Medical residency modernization
Community-based health care identified and supported
Outlaws health insurance exclusion based on chronic conditions, past medical history, domestic violence, etc.
Allows young adults to remain ensured with their families
Disallows lifetime dollar limits on insurance coverage
We get a “Health Choices Commissioner.”
We get a “Health Insurance Exchange,” with annual standards for basic, enhanced, and premium plans for participating providers. Individuals are “risk-pooled.” Cost credits and premium credits set up to share costs across cooperative enterprise.
Health Secretary legally obliged to set up Annual Review of health insurance premiums increases
Transition to full electronic enrollment and payments
90-days notice for health plan coverage and cost changes
Guarantees “essential benefits,” like maternity care, metal health, physical therapy, and other often-skimped features
Study the feasibility of dental for all adults
Health plan marketing standards
Health plan simplicity standards
Protection against discrimination and bias
Whistle-blower protection
No preemption of any state abortion or federal conscience statutes
(protects conscientious objectors from losing federal funds)
Support for small health care providers
Cost-sharing and affordability credits within Exchange
Small employers (annual payroll under $500,000) protected from employer health coverage mandates
Protects incentives to remain with existing employer-based health insurance plans.
Makes it generally the same cost to the individual whether or not he/she has health insurance. Penalty protection for dependents, nonresident aliens, conscientious objectors, etc.
Modest tax on the rich (individuals making $500,000 and up)
2.5% tax on medical device purchases (non-retail, not for use in further manufacturing process)
No tax credit for shit biofuel (sec. 555)
Physicians’ Assistants recognized with the authority to make Medicare-funding related decisions for extended homecare and hospice patients.
Penalizes excess readmissions.
Provides for a feasibility study of Medicare acquiring DME through a competitive bidding process among manufacturers
Reform process of funding post-acute services under Medicare
Reform process of funding homecare services based on study of variability of outcomes.
Study geographic changes in healthcare services rendered by volume and intensity for Medicare, Medicaid, and other insurance providers.
Build cost stabilization into system, eliminate some general stabilization funds
Study effects of basing Medicare Advantage payments on aggregated geographic data as opposed to county boundaries.
Finalize a plan to encourage “high value health care” through funding changes to Medicare A&B. Submit to Congress.
Authorizes Commissioner to take necessary actions to recover funds arising from annual insurer audits.
Phase out drug prescription coverage “doughnut hole” by 2019. Drug manufacturers pay to the Secretary any drug rebates owed to eligible individuals (eventually goes to individuals? 1181
AIDS drug and Indian Healthcare drug benefits count toward out-of-pocket expenses related to Medicare out-of-pocket spending limits.
No changes to insurance plans during the year for which they were marketed.
Secretary may get involved in negotiations between drug manufacturers and pharmacies.
Automated dose-dispensing for Medicare D-covered drugs
Telehealth Advisory Committee
Study the accuracy of Medicare geographic adjustment factors
1171 limits cost sharing
Requires secretary to publish administrative cost informations for MA
Discounts for Medicare D drugs for individuals falling in the “doughnut hole” coverage gap
PDPs can still outbid the Secretary and obtain better results in the drug market
Temporary increase in rates paid for ground and rural air ambulance services.
Low-income subsidy beneficiaries get retroactive benefits payments automatically without the need to do any paperwork.
Automatic enrollment process for subsidy-qualifiers.
Many of the poorest do not have to count subsidies as a part of their income for low-income qualification in Medicare.
Study the extent to which Medicare services providers use foreign language services in their practices. Formulate payment strategies to incorporate into Medicare.
Pilot programs for Medicare-funded language programs in underserved ethnic minority communities.
Study the impact of language services on the health care of limited-English proficient populations.
Demonstration program on “patient decision aids” to improve health care decision process.
Extend therapy caps exemption, extended months of coverage for immunosuppressive drugs for kidney transplant patients and renal dialysis.
Protects Tricare (military health plan) beneficiaries from limited-enrollment penalty.
Pilot program to test different payment incentive models with a view toward reducing unnecessary costs.
“Medical Home” pilot program to test feasibility of reimbursements for medical home-modeled health care systems. “Patient-centered.” Pilot targets high-need recipients.
Increases reimbursements for nurse-midwives.
Medicare for selected preventive services. 1305
Waives deductible for colorectal cancer screening tests.
Medicare for marriage and family therapist services, mental health counseling services.
Extends Bush’s 2008 Medicare coverage of psychotherapy another two years, to the end of 2011.
Medicare B for all federally recommended vaccines.
Certified diabetes practitioners are Medicare providers.
Center for Comparative Effectiveness Research to research health care methods and outcomes.
Quality assurance, accountability, ethics, and compliance in Nursing Facilities. Performance improvement program. Beef up Nursing Home Compare Medicare Website.
Identify efficiencies in SNFs and fund national background checks for nursing facility direct-patient employees.
Quality indicators and metrics of improvement for Alzheimer’s care.
Disclosure of physicians’ financial relationships to Medicare-covered drug manufacturers.

1 comment:

Mangs said...

Thanks for this. I mean that. I understand shit, like, better. Like, more, like, better.