HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Ins.

[ProSense]

HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance

The U.S. Department of Health and Human Services (HHS) today announced new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan. Premiums for the Federally-administered Pre-Existing Condition Insurance Plan (PCIP) will drop as much as 40 percent in 18 States, and eligibility standards will be eased in 23 States and the District of Columbia to ensure more Americans with pre-existing conditions have access to affordable health insurance. The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.

“The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives,” said HHS Secretary Kathleen Sebelius. “These changes will decrease costs and help insure more Americans.”

In 23 States and the District of Columbia, the PCIP program is Federally-administered. The remaining States operate their own PCIP programs using Federal funds provided by the Affordable Care Act.

Under the changes announced today, PCIP premiums will drop as much as 40 percent in 18 States where the Federally administered PCIP operates. These premium decreases help bring PCIP premiums closer to the rates in each State’s individual insurance market; in the six States where PCIP premiums were already well-aligned with State premiums, premiums will remain the same.

The changes announced today will make enrolling in the Federally-administered PCIP in 23 States and the District of Columbia easier. Starting July 1, 2011, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. Applicants will no longer have to wait on an insurance company to send them a denial letter. This option became available to children under age 19 in February, and this pathway is being extended to all applicants regardless of age. Applicants will still need to meet other eligibility criteria, including that they are U.S. citizens or residing in the U.S. legally and that they have been without health coverage for six months.

HHS also sent letters today to the 27 States running their own programs to inform them of the opportunity to modify their current PCIP premiums.

To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but un-enrolled. Several States have experimented with such payments with good success. This is a part of continuing HHS outreach efforts with States, insurers, providers, and agents and brokers to reach more eligible people and let them know that coverage is available. HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied.

Congress created the temporary PCIP program as part of the Affordable Care Act to help uninsured Americans with a variety of medical conditions get affordable coverage rather than be locked out of the system by insurance companies. In 2014 and beyond, insurers will be prohibited from denying coverage to anyone with a pre-existing condition and new competitive marketplaces called Health Insurance Exchanges will give people the opportunity to shop for the policy that best suits their needs. Millions of Americans also will receive tax credits to help make coverage affordable.

Enrollment in PCIP programs has begun to grow rapidly. In the period between November 2010 and March 2011, enrollment in all programs rose 129 percent to more than 18,000 Americans enrolled in PCIP.

“These changes will get more people covered,” said Steven Larsen, the Director of the Center for Consumer Information and Insurance Oversight. “We’re encouraged by recent increases in enrollment and we’re excited to build on these efforts and reach even more people.”

PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care. It limits annual out-of-pocket spending and does not carve out benefits the people need. Eligibility is not based on income and people who enroll are not charged a higher premium because of their medical condition.

To find a chart showing changes to PCIP premiums in the States with Federally-administered PCIP programs, visit www.HealthCare.gov/news/factsheets/pcip05312011a.html.

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov and click on “Find Your State.” Then select your State from a map of the United States or from the drop-down menu. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

[MannyGoldstein]

1. There were enough Senate votes to pass Medicare buy-in through reconciliation

Just think of how many people could have been quickly covered by that, and how much money we all could have saved?

Oh what a pile of poop we make
When at first we practice to triangulate.

[JoePhilly]

3. Got a link for those votes?

I'd be curious to see who they were.

[MannyGoldstein]

6. For example

http://openleft.com/diary/16552/we-had-a-deal-a-few-senators-just-lied-to-us

[JoePhilly]

10. So you told me what everyone already knew.

There were a handful of Democratic Senators who were playing games and never actually going to vote for it.

[MannyGoldstein]

11. But more than 50 would vote for it

But less than 60. But that's OK, as reconciliation only needs 51.

[JoePhilly]

14. So 2 questions ...

1) who specifically are the 51?

2) why didn't harry use reconciliation?

You'd think Harry would know if he really had the votes.

[Liberal_Stalwart71]

4. Actually, no there wasn't. Too many Blue Dogs wanted to join with the Repukes.

You are wrong on this!

Ben Nelson
Bill Nelson
Blanche Lincoln
Joe LIEberman
Mark Pryor
Mary Landrieu
Amy Klobuchar
Kay Hagan
Claire McCaskill
Kent Conrad
Max Baucus
Robert Byrd
Jim Webb

...and there were several other Senate Democrats who were never going the "Medicare For All" or public option route. I remember taking days off from work to call these and other senators.

You are wrong about that. We never had a chance at Reconciliation.

[TheWraith]

5. For the last time, no. That's not how reconciliation works.

1. We couldn't have passed ANYTHING by reconciliation, since reconciliation had already been used in the past year. One and only one reconciliation bill per year; those are the rules of the Senate.

2. Reconciliation can only be used on budget matters.

3. Reconciliation expires after ten years.

[MannyGoldstein]

7. The current RomneyObamaCare was passed through reconciliation, no?

http://www.nytimes.com/2010/03/26/health/policy/26health.html

Why would passing Medicare for All be any different?

[TheWraith]

20. No, it did not.

Some changes after the fact were included in a reconciliation bill. NOT the whole package, which couldn't possibly have been passed that way.

Furthermore, I still have yet to see where anyone can show me 51 votes in the Senate for single payer.

[eomer]

8. That's not really correct.

There was no need for an additional reconciliation bill - it could have been done in the same reconciliation bill as the final reform package was.

And reconciliation can be used on matters that are budget-related so it could have been used for Medicare expansion if crafted properly. As I mentioned, the final health care reform was passed under reconciliation.

[ProSense]

12. It is correct

The Senate bill did not pass via reconcilation. The vote was 60 - 39.

The only reconciliation vote took place on the final bill, the legislation agreed on by the House and Senate.

Passing a bill via reconcilation is not the same as having the votes for a public option or Medicare for all. In fact, Lieberman, Landrieu and a few others who did not support a public option voted for the bill in reconciliation.

Three members of the Democratic caucus voted against the final bill.

[eomer]

16. No, sorry, the final changes were passed as a reconciliation bill.

In a fitting finale to the yearlong health care saga, the budget reconciliation measure that included the final changes was approved first by the Senate and then by the House on a tumultuous day at the Capitol, as lawmakers raced to complete their work ahead of a two-week recess.

The final House vote was 220 to 207, and the Senate vote was 56 to 43, with the Republicans unanimously opposed in both chambers.

The reconciliation bill makes numerous revisions to many of the central provisions in the measure adopted by the Senate on Dec. 24, including changes in the levels of subsidies that will help moderate-income Americans afford private insurance, as well as changes to the increase in the Medicare payroll tax that will take effect in 2013 and help pay for the legislation.

The bill also delays the start of a new tax on high-cost employer-sponsored insurance policies to 2018 and raises the thresholds at which policies are hit by the tax, reflecting a deal struck by the White House and organized labor leaders. It also includes changes to close the gap in Medicare prescription drug coverage known as the doughnut hole, and to clarify a provision requiring insurers to allow adult children to remain on their parents’ insurance policies until their 26th birthday.

Many of the changes were intended to address the concerns of House Democrats, as well as to bridge differences between the original House and Senate bills and to incorporate additional provisions sought by Mr. Obama.

http://www.nytimes.com/2010/03/26/health/policy/26health.html

These were the final changes to health care reform and they were done in a reconciliation bill. The Senate vote was 56 to 43. There were a number of substantive changes in that final bill. A public option or some other expansion of Medicare could have been included in it, with 50 votes in the Senate.

[ProSense]

17. Wait

didn't I say the final bill passed 56 to 43 via reconciliation?

"These were the final changes to health care reform and they were done in a reconciliation bill. The Senate vote was 56 to 43. There were a number of substantive changes in that final bill. A public option or some other expansion of Medicare could have been included in it, with 50 votes in the Senate."

You are assuming that 50 Senators would have supported such a bill. The bill lost three Senators (four counting Kirk) from the time the Senate version passed. The fact is that Lieberman, Landrieu and a few others would likely have balked. That was up to Reid. If he had the votes, he would have gone for it. Anything else is purely speculation.

[eomer]

18. But you also said "It is correct", seemingly defending the post by TheWraith that I was disputing.

Now it seems you agree with me and not with TheWraith. A public option or some other form of Medicare expansion could have been passed in that final reconciliation bill with 50 votes in the Senate. We apparently agree on that (which is good because it is not really debatable).

Moving on, I haven't made any claims, one way or another, about whether 50 votes could have been accomplished for a public option or some other Medicare expansion. The only way we could know that would be if they had actually tried to get the votes, using sticks and carrots on some Democrats who needed it, and then holding the vote. They did none of that so no one really knows whether it was possible or not. I think they should have tried.

[TheWraith]

21. No, it couldn't have. Reconciliation rules don't allow it.

Reconciliation bills can only handle certain limited matters which impact the budget. A complete HCR package falls well outside that realm.

[eomer]

22. Yes they do allow it and here's the proof.

http://www.npr.org/templates/text/s.php?sId=124009985&m=1

The above article lists numerous examples when it has been done.

Edit to add: and Medicare already exists so it doesn't need to be created - its coverage needs to be expanded, as was done to Medicaid in a reconciliation bill.

[TheWraith]

23. There's a big difference between small tweaks and a major overhaul.

And once again, nobody has presented evidence of 51 votes for single payer.

[eomer]

24. It wouldn't take a major overhaul but you're also wrong that a major overhaul can't be done.

It wouldn't take a major overhaul because you wouldn't have to change Medicare or its benefits in any way. All you need are provisions allowing anyone to buy into it to satisfy the health insurance mandate and then some provisions for how to price it.

But you're also wrong that a major overhaul can't be done through reconciliation. Look at just the table of contents for the health care changes that were made in the Balanced Budget Act of 1997, a reconciliation bill. This looks like a major overhaul to me:

TITLE IV - MEDICARE, MEDICAID, AND
CHILDREN’S HEALTH PROVISIONS

Sec. 4000. Amendments to Social Security Act and references to OBRA; table of
contents of title.
Subtitle A—Medicare+Choice Program
CHAPTER 1—MEDICARE+CHOICE PROGRAM
SUBCHAPTER A—MEDICARE+CHOICE PROGRAM
Sec. 4001. Establishment of Medicare+Choice program.
‘‘PART C—MEDICARE+CHOICE PROGRAM
‘‘Sec. 1851. Eligibility, election, and enrollment.
‘‘Sec. 1852. Benefits and beneficiary protections.
‘‘Sec. 1853. Payments to Medicare+Choice organizations.
‘‘Sec. 1854. Premiums.
‘‘Sec. 1855. Organizational and financial requirements for Medicare+Choice organizations;
provider-sponsored organizations.
‘‘Sec. 1856. Establishment of standards.
‘‘Sec. 1857. Contracts with Medicare+Choice organizations.
‘‘Sec. 1859. Definitions; miscellaneous provisions.
Sec. 4002. Transitional rules for current medicare HMO program.
Sec. 4003. Conforming changes in medigap program.
SUBCHAPTER B—SPECIAL RULES FOR MEDICARE+CHOICE MEDICAL SAVINGS ACCOUNTS
Sec. 4006. Medicare+Choice MSA.
CHAPTER 2—DEMONSTRATIONS
SUBCHAPTER A—MEDICARE+CHOICE COMPETITIVE PRICING DEMONSTRATION PROJECT
Sec. 4011. Medicare prepaid competitive pricing demonstration project.
Sec. 4012. Administration through the Office of Competition; advisory committee.
Sec. 4013. Project design based on FEHBP competitive bidding model.
SUBCHAPTER B—SOCIAL HEALTH MAINTENANCE ORGANIZATIONS
Sec. 4014. Social health maintenance organizations (SHMOs).
SUBCHAPTER C—MEDICARE SUBVENTION DEMONSTRATION PROJECT FOR MILITARY
RETIREES
Sec. 4015. Medicare subvention demonstration project for military retirees.
H. R. 2015—21
SUBCHAPTER D—OTHER PROJECTS
Sec. 4016. Medicare coordinated care demonstration project.
Sec. 4017. Orderly transition of municipal health service demonstration projects.
Sec. 4018. Medicare enrollment demonstration project.
Sec. 4019. Extension of certain medicare community nursing organization demonstration
projects.
CHAPTER 3—COMMISSIONS
Sec. 4021. National Bipartisan Commission on the Future of Medicare.
Sec. 4022. Medicare Payment Advisory Commission.
CHAPTER 4—MEDIGAP PROTECTIONS
Sec. 4031. Medigap protections.
Sec. 4032. Addition of high deductible medigap policies.
CHAPTER 5—TAX TREATMENT OF HOSPITALS PARTICIPATING IN PROVIDER-SPONSORED
ORGANIZATIONS
Sec. 4041. Tax treatment of hospitals which participate in provider-sponsored organizations.
Subtitle B—Prevention Initiatives
Sec. 4101. Screening mammography.
Sec. 4102. Screening pap smear and pelvic exams.
Sec. 4103. Prostate cancer screening tests.
Sec. 4104. Coverage of colorectal screening.
Sec. 4105. Diabetes self-management benefits.
Sec. 4106. Standardization of medicare coverage of bone mass measurements.
Sec. 4107. Vaccines outreach expansion.
Sec. 4108. Study on preventive and enhanced benefits.
Subtitle C—Rural Initiatives
Sec. 4201. Medicare rural hospital flexibility program.
Sec. 4202. Prohibiting denial of request by rural referral centers for reclassification
on basis of comparability of wages.
Sec. 4203. Hospital geographic reclassification permitted for purposes of disproportionate
share payment adjustments.
Sec. 4204. Medicare-dependent, small rural hospital payment extension.
Sec. 4205. Rural health clinic services.
Sec. 4206. Medicare reimbursement for telehealth services.
Sec. 4207. Informatics, telemedicine, and education demonstration project.
Subtitle D—Anti-Fraud and Abuse Provisions and Improvements in Protecting
Program Integrity
CHAPTER 1—REVISIONS TO SANCTIONS FOR FRAUD AND ABUSE
Sec. 4301. Permanent exclusion for those convicted of 3 health care related crimes.
Sec. 4302. Authority to refuse to enter into medicare agreements with individuals
or entities convicted of felonies.
Sec. 4303. Exclusion of entity controlled by family member of a sanctioned individual.
Sec. 4304. Imposition of civil money penalties.
CHAPTER 2—IMPROVEMENTS IN PROTECTING PROGRAM INTEGRITY
Sec. 4311. Improving information to medicare beneficiaries.
Sec. 4312. Disclosure of information and surety bonds.
Sec. 4313. Provision of certain identification numbers.
Sec. 4314. Advisory opinions regarding certain physician self-referral provisions.
Sec. 4315. Replacement of reasonable charge methodology by fee schedules.
Sec. 4316. Application of inherent reasonableness to all part B services other than
physicians’ services.
Sec. 4317. Requirement to furnish diagnostic information.
Sec. 4318. Report by GAO on operation of fraud and abuse control program.
Sec. 4319. Competitive bidding demonstration projects.
Sec. 4320. Prohibiting unnecessary and wasteful medicare payments for certain
items.
Sec. 4321. Nondiscrimination in post-hospital referral to home health agencies and
other entities.
CHAPTER 3—CLARIFICATIONS AND TECHNICAL CHANGES
Sec. 4331. Other fraud and abuse related provisions.
H. R. 2015—22
Subtitle E—Provisions Relating to Part A Only
CHAPTER 1—PAYMENT OF PPS HOSPITALS
Sec. 4401. PPS hospital payment update.
Sec. 4402. Maintaining savings from temporary reduction in capital payments for
PPS hospitals.
Sec. 4403. Disproportionate share.
Sec. 4404. Medicare capital asset sales price equal to book value.
Sec. 4405. Elimination of IME and DSH payments attributable to outlier payments.
Sec. 4406. Increase base payment rate to Puerto Rico hospitals.
Sec. 4407. Certain hospital discharges to post acute care.
Sec. 4408. Reclassification of certain counties as large urban areas under medicare
program.
Sec. 4409. Geographic reclassification for certain disproportionately large hospitals.
Sec. 4410. Floor on area wage index.
CHAPTER 2—PAYMENT OF PPS-EXEMPT HOSPITALS
SUBCHAPTER A—GENERAL PAYMENT PROVISIONS
Sec. 4411. Payment update.
Sec. 4412. Reductions to capital payments for certain PPS-exempt hospitals and
units.
Sec. 4413. Rebasing.
Sec. 4414. Cap on TEFRA limits.
Sec. 4415. Bonus and relief payments.
Sec. 4416. Change in payment and target amount for new providers.
Sec. 4417. Treatment of certain long-term care hospitals.
Sec. 4418. Treatment of certain cancer hospitals.
Sec. 4419. Elimination of exemptions for certain hospitals.
SUBCHAPTER B—PROSPECTIVE PAYMENT SYSTEM FOR PPS-EXEMPT HOSPITALS
Sec. 4421. Prospective payment for inpatient rehabilitation hospital services.
Sec. 4422. Development of proposal on payments for long-term care hospitals.
CHAPTER 3—PAYMENT FOR SKILLED NURSING FACILITIES
Sec. 4431. Extension of cost limits.
Sec. 4432. Prospective payment for skilled nursing facility services.
CHAPTER 4—PROVISIONS RELATED TO HOSPICE SERVICES
Sec. 4441. Payments for hospice services.
Sec. 4442. Payment for home hospice care based on location where care is furnished.
Sec. 4443. Hospice care benefits periods.
Sec. 4444. Other items and services included in hospice care.
Sec. 4445. Contracting with independent physicians or physician groups for hospice
care services permitted.
Sec. 4446. Waiver of certain staffing requirements for hospice care programs in
nonurbanized areas.
Sec. 4447. Limitation on liability of beneficiaries for certain hospice coverage denials.
Sec. 4448. Extending the period for physician certification of an individual’s terminal
illness.
Sec. 4449. Effective date.
CHAPTER 5—OTHER PAYMENT PROVISIONS
Sec. 4451. Reductions in payments for enrollee bad debt.
Sec. 4452. Permanent extension of hemophilia pass-through payment.
Sec. 4453. Reduction in part A medicare premium for certain public retirees.
Sec. 4454. Coverage of services in religious nonmedical health care institutions
under the medicare and medicaid programs.
Subtitle F—Provisions Relating to Part B Only
CHAPTER 1—SERVICES OF HEALTH PROFESSIONALS
SUBCHAPTER A—PHYSICIANS’ SERVICES
Sec. 4501. Establishment of single conversion factor for 1998.
Sec. 4502. Establishing update to conversion factor to match spending under sustainable
growth rate.
Sec. 4503. Replacement of volume performance standard with sustainable growth
rate.
H. R. 2015—23
Sec. 4504. Payment rules for anesthesia services.
Sec. 4505. Implementation of resource-based methodologies.
Sec. 4506. Dissemination of information on high per discharge relative values for
in-hospital physicians’ services.
Sec. 4507. Use of private contracts by medicare beneficiaries.
SUBCHAPTER B—OTHER HEALTH CARE PROFESSIONALS
Sec. 4511. Increased medicare reimbursement for nurse practitioners and clinical
nurse specialists.
Sec. 4512. Increased medicare reimbursement for physician assistants.
Sec. 4513. No x-ray required for chiropractic services.
CHAPTER 2—PAYMENT FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES
Sec. 4521. Elimination of formula-driven overpayments (FDO) for certain outpatient
hospital services.
Sec. 4522. Extension of reductions in payments for costs of hospital outpatient services.
Sec. 4523. Prospective payment system for hospital outpatient department services.
CHAPTER 3—AMBULANCE SERVICES
Sec. 4531. Payments for ambulance services.
Sec. 4532. Demonstration of coverage of ambulance services under medicare
through contracts with units of local government.
CHAPTER 4—PROSPECTIVE PAYMENT FOR OUTPATIENT REHABILITATION SERVICES
Sec. 4541. Prospective payment for outpatient rehabilitation services.
CHAPTER 5—OTHER PAYMENT PROVISIONS
Sec. 4551. Payments for durable medical equipment.
Sec. 4552. Oxygen and oxygen equipment.
Sec. 4553. Reduction in updates to payment amounts for clinical diagnostic laboratory
tests; study on laboratory tests.
Sec. 4554. Improvements in administration of laboratory tests benefit.
Sec. 4555. Updates for ambulatory surgical services.
Sec. 4556. Reimbursement for drugs and biologicals.
Sec. 4557. Coverage of oral anti-nausea drugs under chemotherapeutic regimen.
Sec. 4558. Renal dialysis-related services.
Sec. 4559. Temporary coverage restoration for portable electrocardiogram transportation.
CHAPTER 6—PART B PREMIUM AND RELATED PROVISIONS
SUBCHAPTER A—DETERMINATION OF PART B PREMIUM AMOUNT
Sec. 4571. Part B premium.
SUBCHAPTER B—OTHER PROVISIONS RELATED TO PART B PREMIUM
Sec. 4581. Protections under the medicare program for disabled workers who lose
benefits under a group health plan.
Sec. 4582. Governmental entities eligible to elect to pay part B premiums for eligible
individuals.
Subtitle G—Provisions Relating to Parts A and B
CHAPTER 1—HOME HEALTH SERVICES AND BENEFITS
SUBCHAPTER A—PAYMENTS FOR HOME HEALTH SERVICES
Sec. 4601. Recapturing savings resulting from temporary freeze on payment increases
for home health services.
Sec. 4602. Interim payments for home health services.
Sec. 4603. Prospective payment for home health services.
Sec. 4604. Payment based on location where home health service is furnished.
SUBCHAPTER B—HOME HEALTH BENEFITS
Sec. 4611. Modification of part A home health benefit for individuals enrolled under
part B.
Sec. 4612. Clarification of part-time or intermittent nursing care.
Sec. 4613. Study on definition of homebound.
Sec. 4614. Normative standards for home health claims denials.
Sec. 4615. No home health benefits based solely on drawing blood.
Sec. 4616. Reports to Congress regarding home health cost containment.
CHAPTER 2—GRADUATE MEDICAL EDUCATION
SUBCHAPTER A—INDIRECT MEDICAL EDUCATION
Sec. 4621. Indirect graduate medical education payments.
H. R. 2015—24
Sec. 4622. Payment to hospitals of indirect medical education costs for
Medicare+Choice enrollees.
SUBCHAPTER B—DIRECT GRADUATE MEDICAL EDUCATION
Sec. 4623. Limitation on number of residents and rolling average FTE count.
Sec. 4624. Payments to hospitals for direct costs of graduate medical education of
Medicare+Choice enrollees.
Sec. 4625. Permitting payment to nonhospital providers.
Sec. 4626. Incentive payments under plans for voluntary reduction in number of
residents.
Sec. 4627. Medicare special reimbursement rule for primary care combined residency
programs.
Sec. 4628. Demonstration project on use of consortia.
Sec. 4629. Recommendations on long-term policies regarding teaching hospitals and
graduate medical education.
Sec. 4630. Study of hospital overhead and supervisory physician components of direct
medical education costs.
CHAPTER 3—PROVISIONS RELATING TO MEDICARE SECONDARY PAYER
Sec. 4631. Permanent extension and revision of certain secondary payer provisions.
Sec. 4632. Clarification of time and filing limitations.
Sec. 4633. Permitting recovery against third party administrators.
CHAPTER 4—OTHER PROVISIONS
Sec. 4641. Placement of advance directive in medical record.
Sec. 4642. Increased certification period for certain organ procurement organizations.
Sec. 4643. Office of the Chief Actuary in the Health Care Financing Administration.
Sec. 4644. Conforming amendments to comply with congressional review of agency
rulemaking.
Subtitle H—Medicaid
CHAPTER 1—MANAGED CARE
Sec. 4701. State option of using managed care; change in terminology.
Sec. 4702. Primary care case management services as State option without need for
waiver.
Sec. 4703. Elimination of 75:25 restriction on risk contracts.
Sec. 4704. Increased beneficiary protections.
Sec. 4705. Quality assurance standards.
Sec. 4706. Solvency standards.
Sec. 4707. Protections against fraud and abuse.
Sec. 4708. Improved administration.
Sec. 4709. 6-month guaranteed eligibility for all individuals enrolled in managed
care.
Sec. 4710. Effective dates.
CHAPTER 2—FLEXIBILITY IN PAYMENT OF PROVIDERS
Sec. 4711. Flexibility in payment methods for hospital, nursing facility, ICF/MR,
and home health services.
Sec. 4712. Payment for center and clinic services.
Sec. 4713. Elimination of obstetrical and pediatric payment rate requirements.
Sec. 4714. Medicaid payment rates for certain medicare cost-sharing.
Sec. 4715. Treatment of veterans’ pensions under medicaid.
CHAPTER 3—FEDERAL PAYMENTS TO STATES
Sec. 4721. Reforming disproportionate share payments under State medicaid programs.
Sec. 4722. Treatment of State taxes imposed on certain hospitals.
Sec. 4723. Additional funding for State emergency health services furnished to undocumented
aliens.
Sec. 4724. Elimination of waste, fraud, and abuse.
Sec. 4725. Increased FMAPs.
Sec. 4726. Increase in payment limitation for territories.
CHAPTER 4—ELIGIBILITY
Sec. 4731. State option of continuous eligibility for 12 months; clarification of State
option to cover children.
Sec. 4732. Payment of part B premiums.
H. R. 2015—25
Sec. 4733. State option to permit workers with disabilities to buy into medicaid.
Sec. 4734. Penalty for fraudulent eligibility.
Sec. 4735. Treatment of certain settlement payments.
CHAPTER 5—BENEFITS
Sec. 4741. Elimination of requirement to pay for private insurance.
Sec. 4742. Physician qualification requirements.
Sec. 4743. Elimination of requirement of prior institutionalization with respect to
habilitation services furnished under a waiver for home or communitybased
services.
Sec. 4744. Study and report on EPSDT benefit.
CHAPTER 6—ADMINISTRATION AND MISCELLANEOUS
Sec. 4751. Elimination of duplicative inspection of care requirements for ICFS/MR
and mental hospitals.
Sec. 4752. Alternative sanctions for noncompliant ICFS/MR.
Sec. 4753. Modification of MMIS requirements.
Sec. 4754. Facilitating imposition of State alternative remedies on noncompliant
nursing facilities.
Sec. 4755. Removal of name from nurse aide registry.
Sec. 4756. Medically accepted indication.
Sec. 4757. Continuation of State-wide section 1115 medicaid waivers.
Sec. 4758. Extension of moratorium.
Sec. 4759. Extension of effective date for State law amendment.
Subtitle I—Programs of All-Inclusive Care for the Elderly (PACE)
Sec. 4801. Coverage of PACE under the medicare program.
Sec. 4802. Establishment of PACE program as medicaid State option.
Sec. 4803. Effective date; transition.
Sec. 4804. Study and reports.
Subtitle J—State Children’s Health Insurance Program
CHAPTER 1—STATE CHILDREN’S HEALTH INSURANCE PROGRAM
Sec. 4901. Establishment of program.
‘‘TITLE XXI—STATE CHILDREN’S HEALTH INSURANCE PROGRAM
‘‘Sec. 2101. Purpose; State child health plans.
‘‘Sec. 2102. General contents of State child health plan; eligibility; outreach.
‘‘Sec. 2103. Coverage requirements for children’s health insurance.
‘‘Sec. 2104. Allotments.
‘‘Sec. 2105. Payments to States.
‘‘Sec. 2106. Process for submission, approval, and amendment of State child
health plans.
‘‘Sec. 2107. Strategic objectives and performance goals; plan administration.
‘‘Sec. 2108. Annual reports; evaluations.
‘‘Sec. 2109. Miscellaneous provisions.
‘‘Sec. 2110. Definitions.
CHAPTER 2—EXPANDED COVERAGE OF CHILDREN UNDER MEDICAID
Sec. 4911. Optional use of State child health assistance funds for enhanced medicaid
match for expanded medicaid eligibility.
Sec. 4912. Medicaid presumptive eligibility for low-income children.
Sec. 4913. Continuation of medicaid eligibility for disabled children who lose SSI
benefits.
CHAPTER 3—DIABETES GRANT PROGRAMS
Sec. 4921. Special diabetes programs for children with Type I diabetes.
Sec. 4922. Special diabetes programs for Indians.
Sec. 4923. Report on diabetes grant programs.

http://www.gpo.gov/fdsys/pkg/BILLS-105hr2015enr/pdf/BILLS-105hr2015enr.pdf

[Liberal_Stalwart71]

2. Wait, but I thought Barack Obama was a "Black Mascot for Wall Street" who's in the pocket of

the insurance companies!!

:sarcasm::sarcasm:

[Enrique]

9. the link is to the official HHS website

just for everyone's information, since for whatever reason the link is hidden in the OP.

[ProSense]

13. It really requires

a brilliant mind to figure that out.

[Enrique]

15. not really

i was just saying...

[Safetykitten]

19. The awfullness of this HCR never ends.