As Health Care Reform (Patient Protection and Affordable Care Act) continues to roll out (see our Health Care Reform Timeline), it can be difficult as a business owner/employer to stay ahead of the changes (including fees, taxes and possible fines). Be prepared – 2012 will bring several changes to the health care landscape. Some of these include:
Encouraging Integrated Health Systems
The Affordable Care Act improves quality of care by creating incentives for doctors to form accountable care organizations. These organizations allow doctors and other health care professionals to better coordinate patient care. They could help prevent disease and illness and reduce unnecessary hospital admissions or re-admissions.
Incentives will be paid by the Centers for Medicare & Medicaid Services (CMS) for Medicare patients, but many ACOs will also contract for other patients.
Standardization of Coverage Documents
Effective with plan years beginning March 23, 2012, all health insurers and self-insured employers must give people who apply for and enroll in individual or group health plans a standardized Summary of Benefits and Coverage.
This Summary of Benefits Coverage (SBC) must include:
- A four-page Benefit Summary (two-sided, 8 pages maximum)
- Coverage Examples that estimate customer costs based on the specific plan’s benefits for three medical scenarios – Having a Baby, Treating Breast Cancer and Managing Diabetes
- A standard Glossary of medical and insurance terms
- A website and phone number where individuals can get additional information
Quality of Care Reporting
The Department of Health and Human Services is developing rules for how plans report on benefits and how they pay health care providers. The goal is to improve health outcomes via various reporting measures.
Reducing Paperwork and Administrative Costs
Many changes will make billing practices uniform to improve the quality of care. The ACA requires health plans to adopt rules for the secure, confidential and electronic sending of health information. Standard documents could reduce paperwork and administrative duties, lower costs and decrease medical errors.
Grandfathered plans are not required to participate.
Comparative Effectiveness Fee
Reform creates a new comparative effectiveness research fee. Revenue from this fee will fund research to determine the effectiveness of various forms of medical treatment. Effective for plan years ending after September 30, 2012, insurers and self-insured group health plans must pay $1 per participant. The fee increases to $2 per participant in 2013, then to an amount indexed to national health expenditures for future years. The comparative effectiveness fee phases out by 2019.
Stay Informed on Health Care Reform
To learn more about the changing landscape of Health Care Reform, please click any of the links below: