HCR Timeline

Stay up-to-date with all things Health Care Reform - check out the timeline of changes, updates and deadlines below.

Tax on High-Cost Insurance

January 1, 2018

Imposes an excise tax on insurers of employer-sponsored health plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.

Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager.

Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact.

Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager.

Health Care Choice Compacts

January 1, 2016

Employer Requirements

January 1, 2015

Assesses a fee of $2,000 per full-time employee, excluding the first 30 employees, on employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with more than 50 employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees.

Provides for a 23 percentage point increase in the Children’s Health Insurance Program (CHIP) match rate up to a cap of 100%.

Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager.

Increase Federal Match for CHIP

October 1, 2015

Medicare Payments for Hospital-Acquired Infections

Fiscal Year

Reduces Medicare payments to certain hospitals for hospital-acquired conditions by 1%.

For more information on HCR Compliance Deadlines and alerts subscribe to Health Care Reform Milestone Manager.

Expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 138% FPL and provides enhanced federal matching payments for new eligibles.

States have the option to expand coverage to childless adults beginning April 1, 2010

Expanded Medicaid Coverage

January 1, 2014

Presumptive Eligibility for Medicaid

January 1, 2014

Allows all hospitals participating in Medicaid to make presumptive eligibility determinations for all Medicaid-eligible populations.

Proposed Rule: On January 22, 2013, CMS issued a proposed rule addressing issues related to the Medicaid expansion, including presumptive eligibility. The final rule laying out the requirements for presumptive eligibility by hospitals was issued on July 15, 2013.

To get more HCR News check out HCR Central.

Requires U.S. citizens and legal residents to have qualifying health coverage (there is a phased-in tax penalty for those without coverage, with certain exemptions).

Update: On July 1, 2013, HHS issued a final rule that establishes the standards and processes for the Exchanges to determine eligibility for and grant exemptions from the individual shared responsibility payment.

To get more HCR News check out HCR Central.

Individual Requirement to Have Insurance

January 1, 2014

Health Insurance Exchanges

January 1, 2014

Creates state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through the Exchanges and Medicaid and CHIP programs.

Provides refundable and advanceable tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the Exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.

Update: On May 23, 2012, the IRS released final regulations related to the health insurance premium tax credits. Corrections to this regulation were published on July 17, 2012. Additionally, on January 30, 2013, IRS released a final rule on the premium tax credit test for affordability of employer-sponsored insurance.

Health Insurance Premium and Cost Sharing Subsidies

January 1, 2014

Guaranteed Availability of Insurance

January 1, 2014

Requires guarantee issue and renewability of health insurance regardless of health status and allows rating variation based only on age (limited to a 3 to 1 ratio), geographic area, family composition, and tobacco use (limited to 1.5. to 1 ratio) in the individual and the small group market and the Exchanges.

On February 28, 2013, HHS issued a final rule implementing guaranteed availability of insurance.

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Prohibits annual limits on the dollar value of coverage.

Update: On June 28. 2010, HHS issued interim final regulations prohibiting lifetime and annual limits on coverage.

No Annual Limits on Coverage

January 1, 2014

Essential Health Benefits

January 1, 2014

Creates an essential health benefits package that provides a comprehensive set of services, limiting annual cost-sharing to the Health Savings Account limits ($5,950/individual and $11,900/family in 2010). Creates four categories of plans to be offered through the Exchanges, and in the individual and small group markets, varying based on the proportion of plan benefits they cover.

Requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

For more information on HCR Compliance Deadlines and alerts subscribe to Health Care Reform Milestone Manager

Multi-State Health Plans

January 1, 2014

Temporary Reinsurance Program for Health Plans Begins

January 2014

Creates a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals.

Implementation: January 1, 2014 through December 31, 2016

Permits states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.

Basic Health Plan

January 2014

Medicare Advantage Plan Loss Ratios

January 1, 2014

Requires Medicare Advantage plans to have medical loss ratios no lower than 85%.

For more information on HCR Compliance Deadlines and alerts subscribe to Health Care Reform Milestone Manager.

Permits employers to offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in a wellness program and meeting certain health-related standards; establishes 10-state pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

Implementation: Changes to employer wellness plans effective January 1, 2014; 10-state pilot programs established by July 1, 2014

Wellness Programs in Insurance

January 1, 2014

Fees on Health Insurance Sector

January 2014

Imposes new fees on the health insurance sector.

Reduces states’ Medicaid Disproportionate Share Hospital (DSH) allotments and requires the Secretary to develop a methodology for distributing the DSH reductions.

Medicaid Disproportionate Share Hospital Payments

October 2013

Medicare Disproportionate Share Hospital Payments

October 1, 2013

Reduces Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increases payments based on the percent of the population uninsured and the amount of uncompensated care provided.

Creates the Consumer Operated and Oriented Plan (CO-OP) to foster the creation of non-profit, member-run health insurance companies.

Implementation: CO-OPs established by July 1, 2013

CO-OP Health Insurance Plans

July 1, 2013

Financial Disclosure Due

March 31, 2013

Requires disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.

Imposes an excise tax of 2.3% on the sale of any taxable medical device.

Tax on Medical Devices

January 2013

Employer Retiree Coverage Subsidy

January 2013

Eliminates the tax-deduction for employers who receive Medicare Part D retiree drug subsidy payments.

Increases the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and imposes a 3.8% assessment on unearned income for higher-income taxpayers.

Medicare Tax Increase

January 1, 2013

Flexible Spending Account Limits

January 1, 2013

Limits the amount of contributions to a flexible spending account for medical expenses to $2,500 per year, increased annually by the cost of living adjustment.

Increases the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.

Itemized Deductions for Medical Expenses

January 1, 2013

Medicaid Payments for Primary Care

January 1, 2013

Increases Medicaid payments for primary care services provided by primary care doctors to 100% of the Medicare payment rate for 2013 and 2014 (financed with 100% federal funding).

Implementation: January 1, 2013 through December 31. 2014

Provides a one percentage point increase in federal matching payments for preventive services in Medicaid for states that offer Medicaid coverage with no patient cost sharing for services recommended (rated Br B) by the U.S. Preventive Services Task Force and recommended immunizations.

Medicaid Coverage of Preventive Services

January 1, 2013

Medicare Bundled Payment Pilot Program

January 1, 2013

Establishes a national Medicare pilot program to develop and evaluate making bundled payments for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

States indicate to the Secretary of HHS whether they will operate an American Health Benefit Exchange.

Learn more: Where are states in establishing and implementing their health insurance exchanges? Check out HCR Central for the latest news on the ACA and exchanges.

State Notification Regarding Exchanges

January 1, 2013

Extension of CHIP

Fiscal Year 2012

Extends authorization and funding for the Children’s Health Insurance Program (CHIP) through 2015 (current authorization is through 2013).

Reduces Medicare payments that would otherwise be made to hospitals to account for excess (preventable) hospital readmissions.

Reduced Medicare Payments for Hospital Readmissions

October 2012

Medicare Value-Based Purchasing

October 1, 2012

Establishes a hospital value-based purchasing program in Medicare to pay hospitals based on performance on quality measures and requires plans to be developed to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.

Reduces annual market basket updates for inpatient and outpatient hospital services, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals and units and adjusts payments for productivity. Implementation: Beginning fiscal year 2010; productivity adjustments added to market basket update in 2012

Changes in Medicare Provider Rates

August 31, 2012

Data Collection to Reduce Health Care Disparities

March 2012

Requires enhanced collection and reporting of data on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations.

Creates new demonstration projects in Medicaid for up to eight states to pay bundled payments for episodes of care that include hospitalizations and to allow pediatric medical providers organized as accountable care organizations to share in cost-savings.

Implementation: January 1, 2012 through December 31, 2016

Medicaid Payment Demonstration Projects

January 1, 2012

Annual Fees on the Pharmaceutical Industry

January 2012

Imposes new annual fees on the pharmaceutical manufacturing sector.

Establishes procedures for screening, oversight, and reporting for providers and suppliers that participate in Medicare, Medicaid, and CHIP; requires additional entities to register under Medicare.

Fraud and Abuse Prevention

January 2012

Medicare Advantage Plan Payments

January 2012

Reduces rebates paid to Medicare Advantage plans and provides bonus payments to high–quality plans.

Allows providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.

Accountable Care Organizations in Medicare

January 2012

Medicaid Long-Term Care Services

October 1, 2011

Creates the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services and establishes the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities.

Authorizes an Independent Advisory Board, comprised of 15 members nominated by the President and Congress, subject to Senate confirmation, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds targeted growth rates.

Implementation: Funding available October 1, 2011; beginning in 2013, CMS Chief Actuary issues determination of whether Medicare spending exceeds target growth rates; first recommendations would be due January 15, 2014 to take effect in 2015 if the Medicare spending growth rate exceeds the target growth rate.

Medicare Independent Payment Advisory Board

October 1, 2011

Graduate Medical Education

July 1, 2011

Increases the number of Graduate Medical Education (GME) training positions by redistributing currently unused slots and promotes training in outpatient settings.

Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections.

Medicaid Payments for Hospital-Acquired Infections

July 1, 2011

Medicare Independence at Home Demonstration

June 1, 2011

Creates the Independence at Home demonstration program to provide high-need Medicare beneficiaries with primary care services in their home.

Provides grants to states to begin planning for the establishment of American Health Benefit Exchanges and Small Business Health Options Program Exchanges, which facilitate the purchase of insurance by individuals and small employers.

Implementation: Grants awarded starting March 23, 2011; applications will be accepted through October 15, 2014

Funding for Health Insurance Exchanges

March 23, 2011

Changes to Tax-Free Savings Accounts

January 1, 2011

Excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a Health Reimbursement Account or health Flexible Spending Account and from being reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account. Increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the amount used.

Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health

Implementation: Initial strategy due to Congress by January 1, 2011

National Quality Strategy

January 1, 2011

Chronic Disease Prevention in Medicaid

January 1, 2011

Provides 3-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets.

Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home and provides states taking up the option with 90% federal matching payments for two years for health home-related services.

Medicaid Health Homes

January 1, 2011

Medicare Advantage Payment Changes

January 1, 2011

Restructures payments to private Medicare Advantage plans by phasing-in payments set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.

Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Medicare Premiums for Higher-Income Beneficiaries

January 1, 2011

Center for Medicare and Medicaid Innovation

January 1, 2011

Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality.

Implementation: Center established by January 1, 2011

Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment.

Medicare Prevention Benefits

January 1, 2011

Medicare Payments for Primary Care

January 1, 2011

Provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.

Implementation:January 1, 2011 through December 31, 2015

Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap. In 2013, begins phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

Implementation: January 1, 2011 (drug discount) and January 1, 2013 (federal subsidies)

Closing the Medicare Drug Coverage Gap

January 1, 2011

Teaching Health Centers

Fiscal Year 2010

Establishes Teaching Health Centers and provides payments for primary care residency programs in community-based ambulatory patient care centers.

Authorizes $50 million for five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigation.

Implementation: Authorizes funding beginning fiscal year 2011.

Medical Malpractice Grants

Fiscal Year 2010

Medicaid Community-Based Services

October 1, 2010

Provides states with new options for offering home and community-based services through a Medicaid state plan amendment to certain individuals and permits states to extend full Medicaid benefits to individuals receiving home and community-based services under a state plan.

Establishes the National Health Care Workforce Commission to coordinate federal workforce activities and make recommendations on workforce goals and policies and establishes the National Center for Health Workforce Analysis to undertake state and regional workforce data collection and analysis.

Health Care Workforce Commission

September 30, 2010

Coverage of Preventative Services

September 23, 2010

Requires new health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women.

Implementation: Plan or policy years beginning on or after September 23, 2010

Requires new health plans to implement an effective process for allowing consumers to appeal health plan decisions and requires new plans to establish an external review process.

Implementation: Plan or policy years beginning on or after September 23, 2010

Insurance Plan Appeals Process

September 23, 2010

Consumer Protections in Insurance

September 23, 2010

Prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage, rescinding coverage except in cases of fraud, and from denying children coverage based on pre-existing medical conditions or from including pre-existing condition exclusions for children. Restricts annual limits on the dollar value of coverage (and eliminates annual limits in 2014)

Implementation: Plan or policy years beginning on or after September 23, 2010

Extends dependent coverage for adult children up to age 26 for all individual and group policies.

Implementation: Plan or policy years beginning on or after September 23, 2010

Adult Dependent Coverage to Age 26

September 23, 2010

Review of Health Plan Premium Increases

August 16, 2010

Requires the federal government to create a process, in conjunction with states, where insurers have to justify unreasonable premium increases. Provides grants to states for reviewing premium increases.

Implementation: Plan year 2010

Expands eligibility for the 340(B) drug discount program to sole-community hospitals, critical access hospitals, certain children’s hospitals, and other entities.

Expansion of Drug Discount Program Applications Accepted

August 2010

Tax on Indoor Tanning Services

July 1, 2010

Imposes a tax of 10% on the amount paid for indoor tanning services.

Requires the Department of Health and Human Services to develop an internet website to help residents identify health coverage options.

Consumer Website

July 1, 2010

New Prevention Council First Report Due

July 1, 2010

Creates the National Prevention, Health Promotion and Public Health Council to develop a national prevention, health promotion and public health strategy.

Creates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. The plan will be operated by the states or the federal government.

Federal Pre-existing Condition Insurance Plan Enrollment Begins

July 1, 2010

Medicaid Coverage for Childless Adults

April 1, 2010

Creates a state option to provide Medicaid coverage to childless adults with incomes up to 133% of the federal poverty level. (States will be required to provide this coverage in 2014.)

Imposes additional requirements on non-profit hospitals to conduct community needs assessments and develop a financial assistance policy and impose a tax of $50,000 per year for failure to meet these requirements.

New Requirements on Non-profit Hospitals

March 23, 2010

Generic Biologic Drugs

March 2010

Authorizes the Food and Drug Administration to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed.

Establishes the Federal Coordinated Health Care Office to improve care coordination for dual eligibles (people eligible for both Medicare and Medicaid).

Coordinating Care for Dual Eligibles

March 1, 2010

Small Business Tax Credits

January 1, 2010

Provides tax credits to small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for employees. Phase I (2010-2013): tax credit up to 35% (25% for non-profits) of employer cost; Phase II (2014 and later): tax credit up to 50% (35% for non-profits) of employer cost if purchased through an insurance Exchange for two years.

Provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. Further subsidies and discounts that ultimately close the coverage gap begin in 2011.

Medicare Beneficiary Drug Rebate

January 2010

Reinsurance Program for Retiree Coverage

January 1, 2010

Creates a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare.

Implementation: 90 days following enactment until January 1, 2014

Requires the federal government to create a process, in conjunction with states, where insurers have to justify unreasonable premium increases. Provides grants to states for reviewing premium increases.

Review of Health Plan Premium Increases

Plan Year 2010