Welcome back! We’ve gotten through the general reforms and are ready to tackle the exchange. As always, you can follow along at congress.gov, which offers a (very dry) summary and a (even drier) full text version.
Title III (continued)
Specific Medicare Part Reforms
“Subtitle C: Provisions Relating to Part C” talks about reforms to Medicare Part C. Part C is also called “Medicare Advantage Plans”; it’s basically a private company subcontracting for Medicare itself, so that your Medicare benefits are actually served through this company. This section implements the following reforms:
- (It’s the return of the bulleted list! Are you excited?)
- For each market, the amount paid out is set to the average of the bids in the area. This could be problematic if they join forces to raise the bids, but that’s illegal I’m pretty sure, so they figure that won’t happen and it’ll keep the rate competitive. Plus the Secretary is asked to set up some rules to keep the playing field fair, so there you go, problem solved I guess.
- But the plan does add performance bonuses for doing well at providing service, including paying out more if you save Medicare money and paying bonuses if you provide particularly high quality care or manage the care in a particularly efficient way
- Plans are now forbidden from charging more to the beneficiary for chemo, dialysis, or nursing than the original Medicare plans would have charged, so they can’t save money by making it back from people with cancer and charging them more copays
- If things are coded differently for these plans vs the original plans, the Secretary is tasked with adjusting the payouts to handle that. This I think is meant to reduce fraud?
- It also provides a mechanism where you can quit your MA plan and go back to the original Medicare every year, between January and March. That way if your MA plan stinks, you can get out of it
- The Special Needs Plans are extended, so those continue existing
- A new type of MA plan is created that only applies to people in nursing homes
- The Secretary is not required to accept any bid for a plan that would increase costs for beneficiaries or decrease benefits. I think this means those plans don’t get created if the bid isn’t accepted, so that the ones that are available are more likely to be fair.
- The National Association of Insurance Commissioners is created
Subtitle D deals with Medicare part D: “Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans”. Part D is the part that covers prescriptions.
- This section opens strong by instructing the secretary to create a program where people on medicare pay less for brand-name drugs, and spells out the incentives for manufacturers to partake (their brands won’t be covered if they don’t).
- It also creates rules where widows get longer after their spouse’s death before they have to deal with the paperwork to re-assess their eligibility for medicare (1 year)
- If and when the Secretary moves people around between plans, the ACA lays out the information they are required to be presented with so they can understand their new coverage
- The plan allows the Secretary to define classes of drugs, such as antipsychotics or immunosuppressants, that are of particular concern to the overall health of the American people; all drugs in those classes must be covered by medicare part D
- To pay for a lot of this, people who qualify for Part D but at a higher income level pay more in premiums
- The Secretary is asked to enforce reforms in drug dispensing for long-term support care facilities to eliminate waste involved with 30-day refills
- The Secretary is asked to create a complaint system to efficiently resolve complaints and retain the information associated with them
- All sponsors of prescription plans have to provide a uniform appeals process with a toll-free number and a website
- Drugs used to treat AIDS count toward the out-of-pocket limit
Subtitle E deals with “Ensuring Medicare Sustainability“. This funds a lot of the other reforms; first, it adjusts the costs of everything up to compensate for inflation, and secondly, it increases the premiums by income level. It also establishes a board to keep an eye on medicare spending over time. Weirdly enough, it also sets up a study to measure the quality of psychiatric hospitals; I guess those are expensive?
Subtitle F is back to “Health Care Quality Improvements“. It creates the following programs:
- This funds the Center for Quality Improvement and Patient Safety to carry out research and create grants according to that research
- It creates grants for establishing community-based interdisciplinary teams to support primary care doctors
- It creates grants for medication management services for chronic illness
- It creates grants for innovation in emergency care services
- It creates grants for trauma centers on tribal lands
- It creates grants for “patient decision aids” to help people make health care decisions
- A study is funded for researching if better labelling of prescriptions would be useful
- It creates an Office of Women’s Health to study women’s health needs
Subtitle G, “Protecting and Improving Guaranteed Medicare Benefits“, is one of those CYA protections: it states that nothing here can accidentally reduce benefits, and any money saved by the above measures goes right back into Medicare to increase the solvency.
And that’s the end of Title III!