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Patient Protection and Affordable Care Act
Private Insurance

Fri, 2012-04-27 16:48 — healthinfolaw_admin


 

Sec. 1001 Amendments to the Public Health Service Act

 

  • Quality Reporting. The Secretary of Health and Human Services must, after consultation with health care quality experts and other stakeholders, establish requirements for quality reporting by health insurance issuers and group plans in regards to coverage benefits or reimbursement structures that improve outcomes (e.g. case management, care coordination) prevent hospital readmissions (e.g. patient-centered education, discharge planning), improve patient safety (e.g. evidence based medicine), and promote health and wellness.14  Health and wellness activities “include personalized wellness and prevention services” provided by a wellness manager, wellness organization, or health care provider and that focus on issues such as smoking, nutrition, and physical fitness.15
  • Requirements.

  • Issuers and plans must submit annual reports to the Secretary and enrollees pertaining to the ability of the plan or coverage benefits to improve outcomes, prevent hospital readmissions, improve patient safety, and promote health and wellness. 16
  • Enrollees must have access to the reports during the open enrollment period.17
  • The Secretary must publish the reports on the Internet for public consumption.18
  • The Secretary may establish penalties for noncompliance with the reporting requirements as well as exceptions for certain requirements for issuers and plans “that substantially meet the goals of this section.”19
  • Limitations. The ACA places limitations on the collection, dissemination and use, by the Secretary, health plans and issuers, of information regarding an individual’s lawful ownership, possession, or use of a firearm or ammunition.20 In particular, wellness and prevention programs may not require disclosure of such information, the Secretary may not collect or store such information in a database, and such information cannot be used to affect premium rates, discounts, or rewards.21
  • Regulations. The Secretary must establish, within two years of the ACA’s enactment, regulations containing criteria for “determining whether a reimbursement structure is” subject to the quality reporting requirements.22 Within 180 days of the Secretary’s promulgation of these regulations, the GAO must conduct a review of the regulations and submit a report to Congress describing their impact on the quality and cost of health care.23

    •  

    Sec. 1201 Amendment to the Public Health Service Act

     

    Health Insurers and employee sponsored wellness programs –that meet certain requirements–may not discriminate against participants and beneficiaries based on their health status.24 The Secretary of Health and Human Services must submit a report to Congress three years after passage of the ACA that details the efficacy of employer sponsored wellness programs in preventing disease and promoting health, the impact on access to care, and the impact of cost-sharing and premium based incentives on participants’ behavior.25

     

    Footnotes

    • 14. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(a)(1)(A)-(D).
    • 15. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(b).
    • 16. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(a)(2)(A).
    • 17. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(a)(2)(B).
    • 18. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(a)(2)(C).
    • 19. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(a)(2)(D)-(E).
    • 20. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(c).
    • 21. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(c).
    • 22. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(d).
    • 23. Affordable Care Act §1001(1); 42 U.S.C. 300gg-17(e).
    • 24. Affordable Care Act §1201(1); 42 U.S.C. 300gg-4(a), (j).
    • 25. Affordable Care Act §1201(1); 42 U.S.C. 300gg-4 (m).

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