Assignment: Provisions of Law
Assignment: Provisions of Law
The ACA is intended to provide insurance coverage to 32 million Americans who otherwise would be uninsured, leaving about 6 percent of the nation uninsured (about 20 million were insured under the ACA through the 2016 open enrollment period ending in February 2016 [HHS 2016a]). The original cost estimate for the act was $940 billion over ten years. Later 2013 CBO estimates put the ten-year cost at $1.363 trillion (CBO 2014). While a more detailed analysis of the reform law is provided in chapters 6 and 16, a brief review of payment reform provided by the Kaiser Family Foundation (2013a) includes the following:
◆ Beginning in 2010, provisions in the law reduced the annual Medicare updates for inpatient and hospital services, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals. The American Hospital Association (2016a) has estimated that hospitals alone have absorbed $136 billion in federal cuts to reimbursement in a variety of ways.
◆ Beginning in 2011, provisions in the law reduced the “donut hole” in Medicare Part D (outpatient drug benefit) established by the 2003 Medicare Modernization Act.
◆ In 2012, provisions in the law allowed providers to organize as accountable care organizations (ACOs) and share Medicare savings as a result. Also in 2012, provisions established a Hospital Value-Based Purchasing Program for hospital payments based on performance, and provisions under the Readmission Reduction Program reduced payments to hospitals for patients
who return to the hospital with certain diagnosed conditions within 30 days of their prior admission for the same condition.
◆ In 2013, provisions in the law allowed for demonstration projects in bundled payment under the Bundled Payments for Care Improvement (BPCI) initiative. (Bundled payment projects demonstrated improved quality at reduced expense and therefore were extended to all hospitals for joint replacements in 2016.) Also starting in 2013, provisions reduced Disproportionate Share Hospital payments.
◆ Under the provisions of the law, starting in 2014, Medicare Advantage Plans were required to have medical loss ratios no lower than 85 percent, and payments to hospitals with hospital-acquired infections were reduced.
In April 2015 President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA), which affected physician reimbursement under Medicare Part B in the following significant ways:
◆ It repealed the sustainable growth rate (SGR) established under the Balanced Budget Act of 1997. CMS used the SGR to determine annual Part B increases.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.