Do you need to learn the basics about the Affordable Care Act (ACA)? On May 23, at 2:00 pm Eastern Daylight Time, the Department of Health and Human Services (HHS) is offering a webinar “The Health Care Law 101”. The presentation will be on the main provisions in the ACA, and how to access care in your community. Information on the Health Insurance Marketplace, how to help enroll others in health insurance, and how to receive updates on implementation of the law will also be shared.
Additionally, the National Health Law program has a new resource entitled “Ensuring Accessibility for Individuals with Disabilities in the ACA’s Marketplaces”. It provides an excellent overview of what state advocates should know about the ACA and accessibility features.
A recent study published in the Annals of Internal Medicine found that 22% of 256 medical specialists in four US cities could not serve a patient who uses a wheelchair. The doctors said that people who used wheelchairs could not get into their inaccessible building, could not get onto an exam table, or would not be able to receive assistance to transfer to an exam table. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%). The journal published an editorial that describes the study and refers to a requirement in the Affordable Care Act that the Access Board develop accessibility standards for medical diagnostic equipment. Proposed standards were published in February 2012 and an advisory committee is working on refinements.
Last week, the final rule was released describing essential health benefits that plans will need to cover when the health insurance exchanges begin in 2014. The law outlines 10 broad categories of care, including emergency services, maternity care, hospital and doctors’ services, rehabilitative and habilitative services and devices, mental health and substance abuse care and prescription drugs. The Arc and other advocates had urged HHS to better define what is included in the categories and what would be a sufficient benefit. The final rules do not vary greatly from the proposed rules and give states much flexibility in what will be covered in the 10 categories.
Under the Affordable Care Act (ACA), states must raise the Medicaid fees they pay for primary care services provided by family physicians, internists, pediatricians, and nurse practitioners and physician assistants to the level Medicare pays for those services. The federal government will cover 100% of the increased payments which became effective January 1, 2013 and will continue through 2014. The purpose of this section of the ACA was to increase the availability of primary care providers in anticipation of increased demand beginning in 2014 under Medicaid expansion. On average, in 2012, the fees paid for Medicaid primary care services were about 58% of those paid by Medicare. The increase will especially benefit individuals who are eligible for Medicare and Medicaid since primary care providers now will receive the full Medicare amount. Additional information about the increased primary care service fees is available from the Kaiser Commission on Medicaid and the Uninsured.
Last week, the Department of Health and Human Services (HHS) released a number of proposed regulations and guidance regarding the Affordable Care Act. The regulations address the essential health benefits that must be included in the health insurance plans sold in the private state exchange insurance market place. The Arc is very concerned about the lack of definition of habilitation in the proposed rule and will carefully review the regulations.
HHS also released proposed rules on the health insurance market reforms that will take effect in 2014. The reforms include guaranteed availability of coverage, fair health insurance premiums, and guaranteed renewability of coverage. Comments on these critical rules are due December 26, 2012.
The U.S. Supreme Court sent the Liberty University v. Geithner case back to the Fourth Circuit Court of Appeals. Liberty University had been challenging both the individual mandate and the employer mandate in the Affordable Care Act (ACA) based on claims of violation of religious freedom and claims that it was beyond Congress’s powers under the Constitution. The Fourth Circuit had previously ruled on procedural grounds that Liberty could not sue to stop the mandates. The Supreme Court’s order means that the Fourth Circuit must review the case given the Supreme Court’s decision earlier this year that the individual mandate was constitutional. The Supreme Court has not addressed the employer mandate.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius extended the deadline to December 14th for state officials to notify HHS that they will operate health insurance exchanges. The Affordable Care Act requires the federal government to run the private health insurance marketplaces in states that do not elect to create exchanges.
The Affordable Care Act (ACA) reconciled low reimbursement rates in the Medicaid program by providing temporary rate increases to encourage more doctor participation in the Medicaid program. The rule implementing this provision will be published this week. It provides that states reimburse certain primary care physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs. It provides 100 percent federal matching funds for the difference in payment between the applicable Medicare payment in those years and the Medicaid rate in effect as of July 1, 2009.
The Arc has joined over 50 national organizations to develop a technical assistance paper to help state advocates and state policy makers decide on the rehabilitative and habilitative benefits required by the Affordable Care Act (ACA). One important feature of the ACA is the requirement that all qualified health benefit plans include 10 categories of essential health benefits. While all are important to people with disabilities, the inclusion of the category of rehabilitative and habilitative services and devices is of particular importance to people with intellectual and developmental disabilities. Each state has a great deal of flexibility to create its essential benefit package. The states will choose a state benchmark plan and if that plan does not include services in each of the 10 category areas it must be changed and the necessary services added. The Arc hopes that advocates will find this document, which represents a consensus among national disability groups, useful on the state level.
Following the U.S. Supreme Court decision affirming the constitutionality of the Affordable Care Act (ACA), The Arc released a thorough analysis of the ACA and the benefits for individuals with disabilities. Numerous ACA provisions related to both acute care and long term services and supports hold great promise for improving the health and well-being of people with disabilities.
The report summarizes major provisions of the ACA and the status of the implementation. To complement the longer report, a one page summary is now available on The Arc’s website.