Thursday, January 3, 2013

2013 Healthcare Reform Provisions

A new year means new provisions to be put in in place under the Affordable Care Act. There are four provisions slated to go into effect this year, three of them went into effect on January 1st.

The first provision provides new funding to state Medicaid programs that choose to cover preventative services for patients at little or no cost. The program provides states with a 1 percentage point increase in federal matching payments to provide these services.

Another provision requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government, and is a ramp up to Medicaid providers serving more patients in 2014.

The final provision that was effective on New Year’s Day establishes a national pilot program on payment “bundling”.  Under payment bundling, hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.

Under a fourth provision of the Affordable Care Act, effective on October 1, 2013, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. This is provided under the existing Children’s Health Insurance Program, or CHIP, plan.

Also, as NAHAM News has written before, open enrollment for state health insurance exchanges will begin this year for coverage beginning on January 1, 2014.  

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