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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