Posts Tagged ‘ H.R. 3962 ’
Over the past year the House and the Senate have been working on an effort to provide health insurance reform that lowers costs. Obama has now put forth a proposal that incorporates the work of the House and Senate. This proposal adds additional ideas from Republican members of Congress. It makes insurance more affordable by providing the largest middle class tax cut for health care. It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have. It will end discrimination against Americans with pre-existing conditions.
One key improvement is eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid. The proposal completely closes the Medicare prescription drug “donut hole” coverage gap. It strengthens the Senate bill’s provisions that make insurance affordable for individuals and families. The threshold for the excise tax on the most expensive health plans will be raised from $23,000 for a family plan to $27,500 and will start in 2018 for all such plans. And another important idea included is improving insurance protections for consumers and creating a new Health Insurance Rate Authority to review and rein in unreasonable rate increases and other unfair practices of insurance plans.
Download the full PDF of the President’s key improvements.
• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
• It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
• Closing the Medicare prescription drug “donut hole” coverage gap;
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families;
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans;
• Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.
•
Increase Tax Credits for Health Insurance Premiums
The House and Senate health insurance bills lower premiums through increased competition, oversight, and new accountability standards set by insurance exchanges. The bills also provide tax credits and reduced cost sharing for families with modest income. Relative to the Senate bill, the President’s Proposal lowers premiums for families with income below $44,000 and above $66,000. Relative to the House bill, the proposal makes premiums less expensive for families with income between roughly $55,000 and $88,000. The President’s Proposal also improves the cost sharing assistance for individuals and families relative to the Senate bill. Families with income below $55,000 will get extra assistance; the additional funding to insurers will cover between 73 and 94% of their health care costs.
Close the Medicare Prescription Drug “Donut Hole”.
The Medicare drug benefit provides vital help to seniors who take prescription drugs, but under current law, it leaves many beneficiaries without assistance when they need it most. Medicare stops paying for prescriptions after the plan and beneficiary have spent $2,830 on prescription drugs, and only starts paying again after out-of-pocket spending hits $4,550. This “donut hole” leaves seniors paying the full cost of expensive medicines, causing many to skip doses or not fill prescriptions at all. The Senate bill provides a 50% discount for certain drugs in the donut hole. The House bill fully phases out the donut hole over 10 years. Both bills raise the dollar amount before the donut hole begins by $500 in 2010.
Invest in Community Health Centers.
About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.
Strengthen Oversight of Insurance Premium Increases.
Both the House and Senate bills include significant reforms to make insurance fair, accessible, and affordable to all people, regardless of pre-existing conditions. One essential policy is “rate review” meaning that health insurers must submit their proposed premium increases to the State authority or Secretary for review.
Extend Consumer Protections against Health Insurer Practices.
The Senate bill includes a “grandfather” policy that allows people who like their current coverage, to keep it. The President’s Proposal adds certain important consumer protections to these “grandfathered” plans. Within months of legislation being enacted, it requires plans to cover adult dependents up to age 26, prohibits rescissions, mandates that plans have a stronger appeals process, and requires State insurance authorities to conduct annual rate review, backed up by the oversight of the HHS Secretary. When the exchanges begin in 2014, the President’s Proposal adds new protections that prohibit all annual and lifetime limits, ban pre-existing condition exclusions, and prohibit discrimination in favor of highly compensated individuals. Beginning in 2018, the President’s Proposal requires “grandfathered” plans to cover proven preventive services with no cost sharing.
Improve Individual Responsibility.
The House and Senate bills require individuals who have affordable options but who choose to remain uninsured to make a payment to offset the cost of care they will inevitably need. The House bill’s payment is a percentage of income. The Senate sets the payment as a flat dollar amount or percentage of income, whichever is higher (although not higher than the lowest premium in the area). Both the House and Senate bill provide a low-income exemption, for those individuals with incomes below the tax filing threshold (House) or below the poverty threshold (Senate). The President’s Proposal raises the percent of income that is an alternative payment amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 to 2.5% for 2016 and subsequent years – the same percent of income as in the House bill, which makes the assessment more progressive.
Strengthen Employer Responsibility.
Under the Senate bill, there is no mandate for employers to provide health insurance. But as a matter of fairness, the Senate bill requires large employers (i.e., those with more than 50 workers) to make payments only if taxpayers are supporting the health insurance for their workers. The assessment on the employer is $3,000 per full-time worker obtaining tax credits in the exchange if that employer’s coverage is unaffordable, or $750 per full-time worker if the employer has a worker obtaining tax credits in the exchange but doesn’t offer coverage in the first place. The House bill requires a payroll tax for insurers that do not offer health insurance that meets minimum standards. The tax is 8% generally and phases in for employers with annual payrolls from $500,000 to $750,000; according to the Congressional Budget Office (CBO), the assessment for a firm with average wages of $40,000 would be $3,200 per worker. The President’s Proposal, small businesses will receive $40 billion in tax credits to support coverage for their workers beginning this year. Consistent with the Senate bill, small businesses with fewer than 50 workers would be exempt from any employer responsibility policies.
Comprehensive Sanctions Database.
The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities. (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
Registration and Background Checks of Billing Agencies and Individuals.
In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs (Source: H.R. 3970, “Medical Rights & Reform Act” ( Kirk bill))
Expanded Access to the Healthcare Integrity and Protection Data Bank.
Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program. It includes criminal penalties for misuse. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers.
In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Community Mental Health Centers.
The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers.
The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund. It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Use of Technology for Real-Time Data Review.
The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse. (Source: Roskam Amendment offered in House Ways & Means Committee markup)
Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges.
Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year. Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives. Many beneficiaries unwittingly give over this personal information without ever receiving promised services. The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
Study of Universal Product Numbers Claims Forms for Selected Items and Services under the Medicare Program.
The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse. (Source: H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), Roskam Amendment offered in House Ways & Means Committee markup)
Medicaid Prescription Drug Profiling.
The President’s Proposal requires States to monitor and remediate high-risk billing activity, not limited to prescription drug classes involving a high volume of claims, to improve Medicaid integrity and beneficiary quality of care. States may choose one or more drug classes and must develop or review and update their care plan to reduce utilization and remediate any preventable episodes of care where possible. (Source: President’s FY 2011 Budget)
Medicare Advantage Risk Adjustment Errors.
The President’s Proposal requires in statute that the HHS Secretary extrapolate the error rate found in the risk adjustment data validation (RADV) audits to the entire Medicare Advantage contract payment for a given year when recouping overpayments. Extrapolating risk score errors in MA plans is consistent with the methodology used in the Medicare fee-for-service program and enables Medicare to recover risk adjustment overpayments (Source: President’s FY 2011 Budget)
Modify Certain Medicare Medical Review Limitations.
The Medicare Modernization Act of 2003 placed certain limitations on the type of review that could be conducted by Medicare Administrative Contractors prior to the payment of Medicare Part A and B claims. The President’s Proposal modifies these statutory provisions that currently limit random medical review and place statutory limitations on the application of Medicare prepayment review. (Source: President’s FY 2011 Budget)
Establish a CMS-IRS Data Match to Identify Fraudulent Providers.
The President’s Proposal authorizes the Centers for Medicare & Medicaid Services (CMS) to work collaboratively with the Internal Revenue Service (IRS) to determine which providers have seriously delinquent tax debt to help identify potentially fraudulent providers sooner. The data match will primarily target certain high-risk provider types in high-vulnerability areas. (Source: President’s FY 2011 Budget)
Preventing Delays in Access to Generic Drugs.
Brand-name pharmaceutical companies can delay generic competition through agreements whereby they pay the generic company to keep its drug off the market for a period of time, called “pay-for-delay.” The President’s proposal adopts a provision from the bipartisan legislation that gives the FTC enforcement authority to address this problem. Specifically, it makes anti-competitive and unlawful any agreement in which a generic drug manufacturer receives anything of value from a brand-name drug manufacturer that contains a provision in which the generic drug manufacturer agrees to limit or forego research, development, marketing, manufacturing or sales of the generic drug.
Republican Ideas Included in the President’s Proposal
• Includes personal responsibility incentives: Allows health insurance premium to vary based on participation in proven employer wellness programs
o (Sources: H.R. 3468, “Promoting Health and Preventing Chronic Disease through Prevention and Wellness Programs for Employees, Communities, and Individuals Act” (Castle bill); H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), “Coverage, Prevention and Reform Act”)
• Advances medical liability reform through grants to States: Provides grants to States to jump-start and evaluate promising medical liability reform ideas to put patient safety first, prevent medical errors, and reduce liability premiums.
o (Sources: S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 4529, “Roadmap for America’s Future Act” (Ryan bill); S. 1099, “Patients’ Choice Act” (Burr-Coburn, Ryan-Nunes bill))
• Extends dependent coverage to age 26: Gives young adults new options.
o (Sources: H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
• Allows automatic enrollment by employers in health insurance: Allows employee to opt-out.
o (Sources: House Republican Substitute; H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); “Coverage, Prevention, and Reform Act” )
• Mechanisms to improve quality.
o (Sources: H.R. 4529, “Roadmap for America’s Future Act;” S. 1099, “Patients’ Choice Act;” H.R. 3400, Republican Study Group bill; S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill))
• Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.
o (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
• Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs. It ensures that entities that bill for Medicare on behalf of providers are in good standing. It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Expanded Access to the Healthcare Integrity and Protection Data Bank. Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program. It includes criminal penalties for misuse.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund. It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse.
o (Source: Roskam Amendment offered in House Ways & Means Committee markup)
• Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges. Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year. Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives. Many beneficiaries unwittingly give over this personal information without ever receiving promised services. The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.
o (Source: H.R. 3970, “Medical Rights & Reform Act”)
• Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.
o (Source: H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)
Get Emptysuit On Twitter
Click On Links:
H.R. 3962 Summary
Affordable Health Care For America Act “H.R. 3962″
Obama’s Health Care, A Bad Idea
H.R. 3962 Tax Hikes
The Votes On H.R.3962
Obama Health Reform Lies
Impeach Obama
Bush Billboard, Miss Me Yet?
52% Say Obama Doesn’t Deserve Reelection In 2012
2011 Budget Summary
2011 Budget Terminations, Reductions And Savings
US Voters Want Congress To Drop Health
Obama Signs $1.1 Trillion Spending Bill
Earmarks In The $1.1T Federal Spending Bill
About Emptysuit
Your Opinion
Obama Seeks $1.1 Trillion In Tax Hikes
The House Negro And The Field Negro
Around 21 million people are expected to get coverage through the exchange by 2019, according to the Congressional Budget Office. Abortion coverage is widely available in the private market.
A law called the Hyde amendment. must be renewed annually, it bars federal funding for abortion except in cases of rape, incest or if the mother’s life is in danger. The restrictions apply to Medicaid, forcing states that cover abortions for low-income women to pay for them with state revenues. Separate laws apply the restrictions to the federal employee health plan and the military.
SEC. 222. ESSENTIAL BENEFITS PACKAGE DEFINED.
(e) ABORTION COVERAGE PROHIBITED AS PART OF MINIMUM BENEFITS PACKAGE.
SEC. 258. APPLICATION OF STATE AND FEDERAL LAWS REGARDING ABORTION.
SEC. 259. NONDISCRIMINATION ON ABORTION AND RESPECT FOR RIGHTS OF CONSCIENCE.
SEC. 304. CONTRACTS FOR THE OFFERING OF EXCHANGE PARTICIPATING HEALTH BENEFITS PLANS.
Sec. 341. Availability through Health Insurance Exchange.
(3) PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE.
An affordability credit may not be used for payment for services described in section 222(d)(4)(A).
SEC. 2511. SCHOOL-BASED HEALTH CLINICS.
‘‘(c) USE OF FUNDS. Funds awarded under a grant under this section—
SEC. 2529. POSTPARTUM DEPRESSION.
‘‘SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH SERVICE.
‘‘Any limitation on the use of funds contained in an Act providing appropriations for the Department for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an Act providing appropriations for the Service.
Additional Information:
Complete Bill Text »
4 Page Bill Summary »
10 Page Bill Summary »
Click On Links:
H.R. 3962 Summary
Affordable Health Care For America Act “H.R. 3962″
Obama’s Health Care, A Bad Idea
H.R. 3962 Tax Hikes
The Votes On H.R.3962
Obama Health Reform Lies
Obama’s Brother Samson Obama Accused Of Sex Attack
Impeach Obama
Obama On Abortion
Obama Lies About Abortion Funding in Healthcare Bill
Obama The Devil
Hidden in the 1990 pages of the Affordable Health Care For America Act are the tax hikes. Here is a list included in H.R. 3962. The text of this bill can be read here Complete Bill Text in pdf format. The page number references to each of the tax hikes noted below correspond to those in the pdf.
(Page 275): SEC. 413. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE. (a) IN GENERAL. A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers) but not to exceed the minimum employer contribution described in section 412(b)(1)(A). Any such contribution (1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund; and (2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled. (b) SPECIAL RULES FOR SMALL EMPLOYERS. (1) IN GENERAL. In the case of any employer who is a small employer for any calendar year, subsection (a) shall be applied by substituting the applicable percentage determined in accordance with the following table for ‘‘8 percent’’:
If the annual payroll of such employer for the preceding calendar year: The applicable percentage is:
Does not exceed $500,000 ………………………………. 0 percent
Exceeds $500,000, but does not exceed $585,000 2 percent
Exceeds $585,000, but does not exceed $670,000 4 percent
Exceeds $670,000, but does not exceed $750,000 6 percent
(2) SMALL EMPLOYER.—For purposes of this subsection, the term ‘‘small employer’’ means any employer for any calendar year if the annual payroll of such employer for the preceding calendar year does not exceed $750,000.
(Page 296): SEC. 501. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE. (a) IN GENERAL. Subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new part: ‘‘PART VIII HEALTH CARE RELATED TAXES ‘‘Subpart A Tax on Individuals Without Acceptable Health Care Coverage ‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE. ‘‘(a) TAX IMPOSED. In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of ‘‘(1) the taxpayer’s modified adjusted gross income for the taxable year, over ‘‘(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. ‘‘(b) LIMITATIONS. ‘‘(1) TAX LIMITED TO AVERAGE PREMIUM. ‘‘(A) IN GENERAL. The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year. ‘‘(B) APPLICABLE NATIONAL AVERAGE PREMIUM. ‘‘(i) IN GENERAL. For purposes of subparagraph (A), the ‘applicable national average premium’ means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins. ‘‘(ii) FAILURE TO PROVIDE COVERAGE FOR MORE THAN ONE INDIVIDUAL. In the case of any taxpayer who fails to meet the requirements of subsection (d) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting ‘family coverage’ for ‘self-only coverage’. ‘‘(2) PRORATION FOR PART YEAR FAILURES. The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the amount of tax so imposed (determined without regard to this paragraph and after application of paragraph (1)) as ‘‘(A) the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection (d), bears to ‘‘(B) the entire taxable year. ‘‘(c) EXCEPTIONS. ‘‘(1) DEPENDENTS. Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as such taxable year. ‘‘(2) NONRESIDENT ALIENS. Subsection (a) shall not apply to any individual who is a nonresident alien. ‘‘(3) INDIVIDUALS RESIDING OUTSIDE UNITED STATES. Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable. ‘‘(4) INDIVIDUALS RESIDING IN POSSESSIONS OF THE UNITED STATES. Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year. ‘‘(5) ‘‘(A) IN GENERAL. Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section. ‘‘(B) EXEMPTION.—An application for the exemption described in subparagraph (A) shall be filed with the Secretary at such time and in such form and manner as the Secretary may prescribe. The Secretary may treat an application for exemption under section 1402(g)(1) as an application for exemption under this section, or may otherwise coordinate applications under such sections, as the Secretary determines appropriate. Any such exemption granted by the Secretary shall be effective for such period as the Secretary determines appropriate..
(Page 324): PART 3—LIMITATIONS ON HEALTH CARE RELATED EXPENDITURES SEC. 531. DISTRIBUTIONS FOR MEDICINE QUALIFIED ONLY IF FOR PRESCRIBED DRUG OR INSULIN. (a) HSAS. Subparagraph (A) of section 223(d)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following:‘‘Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin.’’. (b) ARCHER MSAS. Subparagraph (A) of section 220(d)(2) of such Code is amended by adding at the end the following: ‘‘Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin.’’. (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS AND HEALTH REIMBURSEMENT ARRANGEMENTS. Section 106 of such Code is amended by adding at the end the following new subsection: ‘‘(f) REIMBURSEMENTS FOR MEDICINE RESTRICTEDTO PRESCRIBED DRUGS AND INSULIN. For purposes of this section and section 105, reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug or is insulin.’’ (d) EFFECTIVE DATES. The amendment made by this section shall apply to expenses incurred after December 31, 2010.
(Page 325): SEC. 532. LIMITATION ON HEALTH FLEXIBLE SPENDING ARRANGEMENTS UNDER CAFETERIA PLANS. (a) IN GENERAL. Section 125 of the Internal Revenue Code of 1986 is amended (1) by redesignating subsections (i) and (j) as subsections (j) and (k), respectively, and (2) by inserting after subsection (h) the following new subsection: ‘‘(i) LIMITATION ON HEALTH FLEXIBLE SPENDING ARRANGEMENTS. ‘‘(1) IN GENERAL. For purposes of this section, if a benefit is provided under a cafeteria plan through employer contributions to a health flexible spending arrangement, such benefit shall not be treated as a qualified benefit unless the cafeteria plan provides that an employee may not elect for any taxable year to have salary reduction contributions in excess of $2,500 made to such arrangement. ‘‘(2) INFLATION ADJUSTMENT. In the case of any taxable year beginning after 2013, the dollar amount in paragraph (1) shall be increased by an amount equal to ‘‘(A) such dollar amount, multiplied by ‘‘(B) the cost of living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins determined by substituting ‘calendar year 2012’ for ‘calendar year 1992’ in subparagraph (B) thereof. If any increase determined under this paragraph is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.’’. (b) EFFECTIVE DATE. The amendments made by this section shall apply to taxable years beginning after December 31, 2012.
(Page 326): SEC. 533. INCREASE IN PENALTY FOR NONQUALIFIED DISTRIBUTIONS FROM HEALTH SAVINGS ACCOUNTS. (a) IN GENERAL.—Subparagraph (A) of section 223(f)(4) of the Internal Revenue Code of 1986 is amended by striking ‘‘10 percent’’ and inserting ‘‘20 percent’’. (b) EFFECTIVE DATE. The amendment made by this section shall apply to taxable years beginning after December 31, 2010.
(Page 327): SEC. 534. DENIAL OF DEDUCTION FOR FEDERAL SUBSIDIES FOR PRESCRIPTION DRUG PLANS WHICH HAVE BEEN EXCLUDED FROM GROSS INCOME. (a) IN GENERAL. Section 139A of the Internal Revenue Code of 1986 is amended by striking the second sentence. (b) EFFECTIVE DATE. The amendment made by this section shall apply to taxable years beginning after December 31, 2010.
(Page 336): SEC. 551. SURCHARGE ON HIGH INCOME INDIVIDUALS. (a) IN GENERAL. Part VIII of subchapter A of chapter 1 of the Internal Revenue Code of 1986, as added by this title, is amended by adding at the end the following new subpart: ‘‘Subpart B—Surcharge on High Income Individuals ‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS. ‘‘(a) GENERAL RULE. In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000. ‘‘(b) TAXPAYERS NOT MAKING A JOINT RETURN. In the case of any taxpayer other than a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), subsection (a) shall be applied by substituting ‘$500,000’ for ‘$1,000,000’. ‘‘(c) MODIFIED ADJUSTED GROSS INCOME. For purposes of this section, the term ‘modified adjusted gross income’ means adjusted gross income reduced by any deduction (not taken into account in determining adjusted gross income) allowed for investment interest (as defined in section 163(d)). In the case of an estate or trust, adjusted gross income shall be determined as provided in section 67(e). ‘‘(d) SPECIAL RULES. ‘‘(1) NONRESIDENT ALIEN. In the case of a nonresident alien individual, only amounts taken into account in connection with the tax imposed under section 871(b) shall be taken into account under this section.
(Page 339): SEC. 552. EXCISE TAX ON MEDICAL DEVICES. (a) IN GENERAL. Chapter 31 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subchapter: ‘‘Subchapter D—Medical Devices ‘‘SEC. 4061. MEDICAL DEVICES. ‘‘(a) IN GENERAL. There is hereby imposed on the first taxable sale of any medical device a tax equal to 2.5 percent of the price for which so sold. ‘‘(b) FIRST TAXABLE SALE. For purposes of this section ‘‘(1) IN GENERAL. The term ‘first taxable sale’ means the first sale, for a purpose other than for resale, after production, manufacture, or importation. ‘‘(2) EXCEPTION FOR SALES AT RETAIL ESTABLISHMENTS.Such term shall not include the sale of any medical device if ‘‘(A) such sale is made at a retail establishment on terms which are available to the general public, and ‘‘(B) such medical device is of a type (and purchased in a quantity) which is purchased by the general public. ‘‘(3) EXCEPTION FOR EXPORTS, ETC. Rules similar to the rules of sections 4221 (other than paragraphs (3), (4), (5), and (6) of subsection (a) thereof) and 4222 shall apply for purposes of this section. To the extent provided by the Secretary, section 4222 may be extended to, and made applicable with respect to, the exemption provided by paragraph (2). ‘‘(4) SALES TO PATIENTS NOT TREATED AS RESALES. If a medical device is sold for use in connection with providing any health care service to an individual, such sale shall not be treated as being for the purpose of resale (even if such device is sold to such individual). ‘‘(c) OTHER DEFINITIONS AND SPECIAL RULES. For purposes of this section ‘‘(1) MEDICAL DEVICE. The term ‘medical device’ means any device (as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act) intended for humans. ‘‘(2) LEASE TREATED AS SALE. Rules similar to the rules of section 4217 shall apply. ‘‘(3) USE TREATED AS SALE. ‘‘(A) IN GENERAL. If any person uses a medical device before the first taxable sale of such device, then such person shall be liable for tax under such subsection in the same manner as if such use were the first taxable sale of such device. ‘‘(B) EXCEPTIONS. The preceding sentence shall not apply to ‘‘(i) use of a medical device as material in the manufacture or production of, or as a component part of, another medical device to be manufactured or produced by such person, or ‘‘(ii) use of a medical device after a sale described in subsection (b)(2). ‘‘(4) DETERMINATION OF PRICE. ‘‘(A) IN GENERAL. Rules similar to the rules of subsections (a), (c), and (d) of section 4216 shall apply for purposes of this section. ‘‘(B) CONSTRUCTIVE SALE PRICE. If ‘‘(i) a medical device is sold (otherwise than through an arm’s length transaction) at less than the fair market price, or ‘‘(ii) a person is liable for tax for a use described in paragraph (3), the tax under this section shall be computed on the price for which such or similar devices are sold in the ordinary course of trade as determined by the Secretary. ‘‘(5) RESALES PURSUANT TO CERTAIN CONTRACT ARRANGEMENTS. ‘‘(A) IN GENERAL. In the case of a specified contract sale of a medical device, the seller referred to in subparagraph (B)(i) shall be entitled to recover from the producer, manufacturer, or importer referred to in subparagraph (B)(ii) the amount of the tax paid by such seller under this section with respect to such sale. ‘‘(B) SPECIFIED CONTRACT SALE. For purposes of this paragraph, the term ‘specified contract sale’ means, with respect to any medical device, the first taxable sale of such device if ‘‘(i) the seller is not the producer, manufacturer, or importer of such device, ‘‘(ii) the price at which such device is so sold is determined in accordance with a contract between the producer, manufacturer, or importer of such device and the person to whom such device is so sold. ‘‘(C) SPECIAL RULES RELATED TO CREDITS AND REFUNDS. In the case of any credit or refund under section 6416 of the tax imposed under this section on a specified contract sale of a medical device ‘‘(i) such credit or refund shall be allowed or made only if the seller has filed with the Secretary the written consent of the producer, manufacturer, or importer referred to in subparagraph (B)(ii) to the allowance of such credit or the making of such refund, and ‘‘(ii) the amount of tax taken into account under subparagraph (A) shall be reduced by the amount of such credit or refund.’’
(Page 344): SEC. 553. EXPANSION OF INFORMATION REPORTING REQUIREMENTS. (a) IN GENERAL. Section 6041 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsections: ‘‘(h) APPLICATION TO CORPORATIONS. Notwithstanding any regulation prescribed by the Secretary before the date of the enactment of this subsection, for purposes of this section the term ‘person’ includes any corporation that is not an organization exempt from tax under section 501(a). ‘‘(i) REGULATIONS. The Secretary may prescribe such regulations and other guidance as may be appropriate or necessary to carry out the purposes of this section, including rules to prevent duplicative reporting of transactions.’’ (b) PAYMENTS FOR PROPERTY AND OTHER GROSS PROCEEDS. Subsection (a) of section 6041 of the Internal Revenue Code of 1986 is amended (1) by inserting ‘‘amounts in consideration for property,’’ after ‘‘wages,’’, (2) by inserting ‘‘gross proceeds,’’ after ‘‘emoluments, or other’’, and (3) by inserting ‘‘gross proceeds,’’ after ‘‘setting forth the amount of such’’. (c) EFFECTIVE DATE. The amendments made by this section shall apply to payments made after December 31, 2011.
(Page 345): SEC. 554. DELAY IN APPLICATION OF WORLDWIDE ALLOCATION OF INTEREST. (a) IN GENERAL. Paragraphs (5)(D) and (6) of section 864(f) of the Internal Revenue Code of 1986 are each amended by striking ‘‘December 31, 2010’’ and inserting ‘‘December 31, 2019’’. (b) TRANSITION. Subsection (f) of section 864 of such Code is amended by striking paragraph (7).
(Page 346): SEC. 561. LIMITATION ON TREATY BENEFITS FOR CERTAIN DEDUCTIBLE PAYMENTS. (a) IN GENERAL. Section 894 of the Internal Revenue Code of 1986 (relating to income affected by treaty) is amended by adding at the end the following new subsection: ‘‘(d) LIMITATION ON TREATY BENEFITS FOR CERTAIN DEDUCTIBLE PAYMENTS. ‘‘(1) IN GENERAL. In the case of any deductible related-party payment, any withholding tax imposed under chapter 3 (and any tax imposed under subpart A or B of this part) with respect to such payment may not be reduced under any treaty of the United States unless any such withholding tax would be reduced under a treaty of the United States if such payment were made directly to the foreign parent corporation. ‘‘(2) DEDUCTIBLE RELATED-PARTY PAYMENT. For purposes of this subsection, the term ‘deductible related-party payment’ means any payment made, directly or indirectly, by any person to any other person if the payment is allowable as a deduction under this chapter and both persons are members of the same foreign controlled group of entities.
(Page 349): SEC. 562. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE; PENALTIES. (a) IN GENERAL. Section 7701 of the Internal Revenue Code of 1986 is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection: ‘‘(o) CLARIFICATION OF ECONOMIC SUBSTANCE DOCTRINE. ‘‘(1) APPLICATION OF DOCTRINE. In the case of any transaction to which the economic substance doctrine is relevant, such transaction shall be treated as having economic substance only if ‘‘(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer’s economic position, and ‘‘(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction. ‘‘(2) SPECIAL RULE WHERE TAXPAYER RELIES ON PROFIT POTENTIAL. ‘‘(A) IN GENERAL. The potential for profit of a transaction shall be taken into account in determining whether the requirements of subparagraphs (A) and (B) of paragraph (1) are met with respect to the transaction only if the present value of the reasonably expected pre-tax profit from the transaction is substantial in relation to the present value of the expected net tax benefits that would be allowed if the transaction were respected. ‘‘(B) TREATMENT OF FEES AND FOREIGN TAXES. Fees and other transaction expenses and foreign taxes shall be taken into account as expenses in determining pre-tax profit under subparagraph (A). ‘‘(3) STATE AND LOCAL TAX BENEFITS. For purposes of paragraph (1), any State or local income tax effect which is related to a Federal income tax effect shall be treated in the same manner as a Federal income tax effect. ‘‘(4) FINANCIAL ACCOUNTING BENEFITS. For purposes of paragraph (1)(B), achieving a financial accounting benefit shall not be taken into account as a purpose for entering into a transaction if the origin of such financial accounting benefit is a reduction of Federal income tax.
(Page 357): SEC. 563. CERTAIN LARGE OR PUBLICLY TRADED PERSONS MADE SUBJECT TO A MORE LIKELY THAN NOT STANDARD FOR AVOIDING PENALTIES ON UNDERPAYMENTS. (a) IN GENERAL. Subsection (c) of section 6664 of the Internal Revenue Code of 1986, as amended by section 562, is amended (1) by redesignating paragraphs (3) and (4) as paragraphs (4) and (5), respectively, (2) by striking ‘‘paragraph (3)’’ in paragraph (4)(A), as so redesignated, and inserting ‘‘paragraph (4)’’, and (3) by inserting after paragraph (2) the following new paragraph: ‘‘(3) SPECIAL RULE FOR CERTAIN LARGE OR PUBLICLY TRADED PERSONS. ‘‘(A) IN GENERAL. In the case of any specified person, paragraph (1) shall apply to the portion of an underpayment which is attributable to any item only if such person has a reasonable belief that the tax treatment of such item by such person is more likely than not the proper tax treatment of such item. ‘‘(B) SPECIFIED PERSON. For purposes of this paragraph, the term ‘specified person’ means ‘‘(i) any person required to file periodic or other reports under section 13 of the Securities Exchange Act of 1934, and ‘‘(ii) any corporation with gross receipts in excess of $100,000,000 for the taxable year involved. All persons treated as a single employer under section 52(a) shall be treated as one person for purposes of clause (ii).’’. (b) NONAPPLICATION OF SUBSTANTIAL AUTHORITY AND REASONABLE BASIS STANDARDS FOR REDUCING UNDERSTATEMENTS. Paragraph (2) of section 6662(d) of such Code is amended by adding at the end the following new subparagraph: ‘‘(D) REDUCTION NOT TO APPLY TO CERTAIN LARGE OR PUBLICLY TRADED PERSONS. Subparagraph (B) shall not apply to any specified person (as defined in section 6664(c)(3)(B)).’’ (c) EFFECTIVE DATE. (1) IN GENERAL. Except as provided in paragraph (2), the amendments made by this section shall apply to underpayments attributable to transactions entered into after the date of the enactment of this Act.
Click On Links:
Affordable Health Care For America Act “H.R. 3962″
Obama Health Reform Lies
H.R. 3962 Summary
Obama’s Health Care, A Bad Idea
Obama On Abortion
Obama’s Health Care, A Bad Idea
Obama Lies About Abortion Funding in Healthcare Bill
Obama’s Health Care Plan
Unveiled by Obama’s Democrats. The Affordable Health Care for America Act H.R. 3962 has been updated with three versions of previous bills passed by the House committees of jurisdiction in July. H.R. 3962 Complete Bill (1990 Pages)
Key Provisions:
Public Health Insurance Option
The Health Insurance Marketplace
Shared Responsibility
Guaranteed Benefits
Making Coverage Affordable
Consumer Protections and Insurance Market Reforms
Employers and Health Reform
Strengthening the Nation’s Health Workforce
Lowering Health Care Costs
Prevention and Wellness
Delivery System Reforms
Preventing Waste, Fraud and Abuse
Strengthening Medicare
Improving Medicare Part D Drug Program
Maintaining and Improving Medicaid
Medicare Advantage
Health Care Surcharge and Households
Health Care Surcharge and Small Businesses
Women Have the Most to Gain
Small Businesses
A Guide for Seniors
Young Americans
Rural Communities
Health Care Disparities
Indian Health
Top 14 Provisions That Take Effect Immediately »
Top 10 Changes to the Health Insurance Reform Bill
What Health Insurance Reform Means for You
Additional Information:
Complete Bill Text »
Top Line Changes »
4 Page Bill Summary »
10 Page Bill Summary »
Click On Links:
Obama Health Reform Lies
H.R. 3962 Summary
Obama’s Health Care, A Bad Idea
Obama On Abortion
Obama’s Health Care, A Bad Idea
Obama Lies About Abortion Funding in Healthcare Bill
Obama’s Health Care Plan
The Affordable Health Care for America Act [H.R. 3962], which blends and updates the three versions of previous bills passed by the House committees of jurisdiction.
DETAILED SUMMARY
Insurance reforms. Prohibits insurance rating based on health status or pre-existing conditions, and limits age rating to 2:1. Prohibits annual or lifetime limits on medical spending. Grandfathers current individual policies.
Exchange. Creates a new marketplace called the national “Health Insurance Exchange”, with an option for states that agree to meet federal standards to run their own exchange.
Eligibility. People are eligible to enter the Exchange and purchase health insurance on their own as long as they are not enrolled in employer sponsored insurance, Medicare or Medicaid. The Exchange is also open to businesses, starting with small firms and growing over time.
Benefits. Outlines broad categories of covered services in the law, and creates a Health Benefits Advisory Commission, with physicians and other expert members, to help the Secretary of HHS define the essential benefit package.
Public health insurance option. The bill establishes a public health insurance option available within the Exchange to ensure choice, competition and accountability. Like other private plans, the public option must survive on its premiums.
New health insurance options. The legislation authorizes start-up loans to assist states with the creation of health insurance co-operatives as an additional option. It also permits states to enter into agreements to allow for the sale of health insurance across state lines when the state legislatures agree to such compacts.
Repealing the antitrust exemption for insurers. The bill promotes competition among health insurers and medical malpractice insurers by removing the antitrust exemption so that it no longer shields these insurers from liability for fixing prices, dividing up territories, or monopolizing their market.
Help for early retirees (temporary reinsurance program). Creates a $10 billion fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.
Limitation on post-retirement reductions of retiree healthcare benefits. Prohibits employers from reducing retirees‘ health benefits after those retirees have retired, unless the reduction is also made to benefits for active participants.
Employers. Employers must either provide health insurance to their employees or make a contribution to help fund affordable health insurance. Employers that choose to offer coverage contribute at least 72.5 percent of premium for workers, 65 percent for families.
Small business protections. Small businesses with annual payrolls below $500,000 are exempt from requirements to offer or contribute to coverage, including the 8 percent payroll contribution for failure to provide health benefits to their workers. There is also a tax credit program to help low-wage small businesses offer coverage to their employees.
Small business tax credits. Small business tax credits are available for businesses with 10 or fewer employees and $20,000 or less in average wages. The credits phase-out if the employer has 25 or more employees or if average wages are $40,000 or more.
Individuals. Individuals are required to obtain health insurance coverage or pay a fee equal to lower of 2.5 percent of their adjusted income above the filing threshold or the average premium on the Exchange. Individuals and families below the income tax filing are exempt.
Government responsibility. It is the responsibility of the federal government to ensure that essential health coverage is affordable and available to all Americans by establishing consumer protections and insurance reforms, affordability credits and overseeing a fair marketplace for people to choose among options.
Affordability credits. Provides financial assistance for premiums and cost sharing for individuals and families with incomes up to 400 percent of the federal poverty level (FPL). Affordability credits are offered on a sliding scale such that premiums range from 1.5 percent of income at the lowest tier to 12 percent at 400 percent FPL.
Eligibility. Affordability credits are available to American citizens and legal residents whose employers do not offer coverage or whose share of employer-sponsored health insurance costs more than 12 percent of their family income.
Caps out-of-pocket spending and limits. Helps prevent medical bankruptcy by limiting out-of pocket costs to no more than $5,000 for individuals and $10,000 for families; these levels are indexed to inflation.
Medicaid and CHIP. Expands Medicaid coverage to everyone within income at or below 150 percent FPL ($33,100 per year for a family of 4) who is not eligible for Medicare. Eliminates assets tests for eligibility groups other than for long-term care. Requires States that now cover those above 150 percent FPL to maintain eligibility.
Revenue. The bill would impose a surcharge on taxpayers with adjusted gross income in excess of $1 million (married filing a joint return) and $500,000 (single) at a rate of 5.4 percent. The bill also clarifies that an employee’s share of premiums for employer-provided coverage offered through the Exchange may be paid on a pre-tax basis through a cafeteria plan.
Hospitals. Substantial delivery and payment system reforms, including productivity adjustments and reductions in market basket updates for most providers, per recommendations from MedPAC, OIG, GAO and others.
Skilled nursing facilities. Follows recommendations from MedPAC and others to encourage payment accuracy that more accurately reflects the costs of services provided.
Medicare DSH payments. Directs the Secretary of HHS to study Medicare DSH payments and report to Congress with recommendations on how best to ensure that DSH is properly targeted to adequately reflect the higher costs of care associated with treating low-income patients.
Graduate medical education. Provides incentives for the training of primary care physicians. Encourages medical residency training in non-hospital settings so that the future physicians of America will be able to provide coordinated care across the spectrum of provider settings.
Hospice moratorium. Extends a one year moratorium on regulatory changes that would phase out the budget neutrality adjustment factor for Hospice providers to ensure that hospices continue to receive the same reimbursement rate for wages for fiscal year 2010.
Reducing potentially preventable hospital readmissions. Changes payment incentives to hospitals and post-acute care providers to discourage preventable hospital readmissions.
Post-acute care bundling. Promotes bundled payments that encourage providers to coordinate a patient’s care across the entire spectrum, from the doctor’s office, to the hospital, through a rehabilitative or nursing facility stay, and back to home.
Center for Medicare & Medicaid Innovation. Establishes a Center for Medicare & Medicaid Innovation to empower CMS to pursue additional payment and delivery system reforms.
Healthcare-associated infections. Requires hospitals and ambulatory surgical centers to report public health information on healthcare-associated infections to the Centers for Disease Control and Prevention.
IOM study of the appropriateness of Medicare payment rates based on geography. Within one year of enactment, the Institute of Medicine is required to report to CMS on the validity of the geographic adjusters that apply to Medicare physician and hospital payments and include any recommendations for improvements.
Productivity adjustments. Expands productivity adjustments to Medicare providers who receive CPI updates in addition to those that receive market basket updates. These providers are: ambulatory surgical centers, ambulances, clinical laboratories, and durable medical equipment not competitively bid.
Accountable Care Organization program. Establishes a new program that allows providers to share in Medicare savings they help create through care coordination and quality improvement initiatives. Ensures that doctors can join with hospitals and others when forming these organizations.
Telehealth. Expands Medicare’s telehealth benefit to beneficiaries who are receiving care at freestanding dialysis centers.
Quality measures. Creates a timely process to allow for a multi-stakeholder group to provide the Secretary with input into the selection of quality measures and provides for consultation by the Secretary of a consensus-based entity in the use of quality measures.
Cost sharing for preventive services. Eliminates deductibles and co-payments for all preventive services covered by the Medicare program.
Improved access to vaccines. Makes it easier for Medicare beneficiaries to get access to needed vaccinations by covering all vaccines under Part B of the program rather than Part D.
Extend Qualified Individuals (QI) program. Extends the QI program two years to help low-income beneficiaries pay their Part B premiums.
Extends months of coverage of immunosuppressive drugs for kidney transplant patients. Lifts the current 36-month limitation on Medicare coverage of immunosuppressive drugs for kidney transplant patients who would otherwise lose this coverage on or after January 1, 2012.
Durable medical equipment in Medicare. Provides protections for beneficiaries receiving oxygen therapy in the event an oxygen supplier goes out of business. Exempts certain pharmacies from the surety bond requirement and the need to be accredited to sell diabetic testing supplies and certain other items.
Payment for imaging services. Instructs CMS to pay more accurately for imaging services in Medicare. Excludes lowtech imaging devices (such as ultrasound, mammograms, EKGs, and x-rays) from the adjustment in payment.
Medicare drug benefit. Eliminates Part D donut hole over time and provides 50 percent discount in donut hole for Part D enrollees. Restores manufacturer rebate for Part D drugs used by dual eligibles, as well as low-income subsidy eligibles after 2015.
Medicare low-income subsidy. Increases eligibility limits by raising assets test and clarifying what counts toward the asset test. Eliminates cost-sharing for certain non-institutionalized dual eligibles.
Encourage accurate dispensing of drugs. Requires that Part D and MA-PD plans develop methods to reduce waste of drugs in the long-term care setting.
Increase use of generics. Increases generic drug utilization by eliminating current requirements that prevent Part D and MA-PD plans from creating incentives for seniors to use lower-cost generic drugs.
Follow-on biologics. Creates an FDA licensure pathway for “biosimilar” generic biological products, allowing these products to come to market and compete with brand name biologics. The biosimilar product must have no clinically meaningful differences in safety, purity or potency from the reference product, and may not be licensed until at least 12 years after the date that the brand-name product was licensed.
Physician Payment Sunshine. Requires manufacturers or distributors to electronically report to the HHS OIG any payments or other transfers of value above a $5 de minimis made to a “covered recipient. Requires hospitals, manufacturers and group purchasing organizations to report the nature of ownership arrangements by physicians.
REDUCIING WASTE,, FRAUD,, AND ABUSE Increases funding by $100 million annually for the Healthcare Fraud and Abuse Control Fund to fight Medicare and Medicaid fraud; improves provider and payment screening to prevent fraud and abuse before it occurs; creates enhanced oversight for Medicare and Medicaid programs at risk of fraud and abuse; creates new penalties for providers and suppliers that defraud federal health care programs; partners with the private sector to reduce waste and abuse by requiring that all Medicare and Medicaid providers establish compliance programs to reduce waste, fraud, and abuse.
PREVENTIION & WELLNESS Creates a grant program to help small and mid-sized employers begin or strengthen workplace wellness programs. These grants will assist in improving the health of our nation’s workforce and will reduce employer health care costs.
Coverage for HIV-positive individuals. Allows State Medicaid programs to cover low-income individuals who are HIV positive through December 31, 2013, after which coverage will be available through the Health Insurance Exchange or, for those with incomes at or below 133 percent of poverty, Medicaid.
Increasing prescription drug rebates. Increases the minimum percentage rebate on brand-name drugs to 23.1 percent of average manufacturer price; extends rebates to new formulations of brand-name drugs; and extends rebate requirement to drugs prescribed by Medicaid managed care organizations.
Reductions in Medicaid DSH payments. Directs the Secretary of HHS to reduce Medicaid DSH payments to States by a total of $10 billion using a methodology that imposes the largest reductions on states with the lowest percentages of uninsured individuals or the least effective targeting of funds on DSH hospitals.
Prohibitions on Medicaid and CHIP payment for undocumented Immigrants. Provides that the Medicaid title does not change current prohibitions against Federal Medicaid or CHIP payments for persons not lawfully present in the U.S.
Primary care residencies in community health centers. Establishes a new grant program to support the development and operation of primary care residency programs in community-based settings such as community health centers.
School-Based health clinics. Establishes a new grants program to support school-based health clinics that provide health services to children and adolescents.
IHS reauthorization. A new division is added to provide for the reauthorization of the Indian Health Care Improvement Act (IHCIA). IHCIA provides the main legal authority for the provision of health care to American Indians and Alaskan Natives.
Additional Information:
Complete Bill Text »
4 Page Bill Summary »
10 Page Bill Summary »
Click On Links:
The Votes On H.R.3962
Obama Health Reform Lies
Hillary Clinton Warned America About Obama
Obama’s Health Care, A Bad Idea
Obama On Abortion
Obama’s Health Care, A Bad Idea
Marine Vet David William Hedrick Rips Rep. Brian Baird
Obama Lies About Abortion Funding in Healthcare Bill
Obama’s Health Care Plan
Obama Say Swine Flue Is Nothing To Worry About
