Most of the provisions in the Affordable Care Act will be implemented between 2010 and 2014, but a few will take place in 2015 and beyond, pertaining to insurance and hospital-acquired conditions as well as another tax revenue provision. In this wind-up of the provisions contained in the act, below are a summary of the changes to take effect beyond implementation of the exchanges in 2014.
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--States will be allowed to form health care compacts that will take effect in 2016. By 2013, the U.S. Department of Health and Human Services will issue regulations for the creation of the health care choice compacts. Under those compacts, two or more states may agree to offer one or more qualified health plans in individual markets in all states. The plans would still be subject to the laws and regulations of the state in which the plan was issued. The issuer of the plan would also be subject to regulation of unfair trade practices and consumer protection standards. Any state participating must enact a law to authorize it to enter a compact agreement.
HHS may approve the compacts if the agency determines that the compact:
--Will provide coverage that is at least as comprehensive as the coverage offered through the exchanges to be set up in 2014;
--Will provide coverage and cost sharing protections against excessive out-of-pocket spending;
--Will not increase the federal deficit; and
--Will not weaken enforcement of laws and regulations relating to insurance in any state that is included in the compact.
--The amount of payment to hospitals in the top 25th percentile of rates for hospital-acquired conditions will be reduced by one percent with respect to discharges occurring during fiscal year 2015 and subsequent years. For some hospitals, an exemption may be given if the state can submit an annual report to HHS describing how a similar program in the state for participating hospitals achieves or surpasses the measured results of the national program with patient health outcomes and cost savings.
--HHS will make information available to the public regarding hospital-acquired conditions on each applicable hospital posted on the Hospital Compare Internet website.
--HHS will also conduct a study on expanding the health care-acquired conditions policy to payments made to other facilities under the Medicare program, including payments made to inpatient rehabilitation facilities, long-term care hospitals, hospital outpatient departments, skilled nursing facilities, ambulatory surgical centers and health clinics. The study will include an analysis of how such policies could impact quality of patient care, patient safety and spending under the Medicare program, and HHS must submit a report on the study to Congress by Jan. 1, 2012.