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A Survey of Indian Health Provisions in Patient Protection a Affordable Care Act

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A Survey of Indian Health Provisions in Patient Protection a Affordable Care Act (Pub.L. 111-148; enacted March 23, 2010) Carol L. Barbero Hobbs, Straus, Dean & Walker, LLP <[email protected]> May, 2010. Enhanced Access to Health Insurance

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Presentation Transcript
A Survey of
  • Indian Health Provisions in
  • Patient Protection a Affordable Care Act
  • (Pub.L. 111-148; enacted March 23, 2010)
  • Carol L. Barbero
  • Hobbs, Straus, Dean & Walker, LLP
  • <[email protected]>
  • May, 2010
Enhanced Access to Health Insurance
  • Expectation: Some 30 million uninsured Americans will gain access to some form of health insurance coverage
    • Medicare, Medicaid, CHIP, private insurance
  • Indian Health Impact:
    • More Indians will be able to acquire coverage
      • Acquire on their own; purchase by tribe; purchase with ISDEAA funds
    • Opportunity for Indian health programs to increase third-party collections
Medicaid Expansion
  • 2010: States allowed (not required) to expand Medicaid to persons up to 133% FPL
    • Regular FMAP applies to expansion
  • 2014: All Medicaid programs required to cover persons at/below 133% FPL
    • Will provide coverage for non-elderly, non-disabled, non-pregnant childless adults who are not currently covered by Medicaid
    • 100% FMAP for expansion population
  • Impact: More Indian people will qualify for Medicaid coverage
Insurance Exchanges; Subsidies
  • “Exchange” = marketplace for information on health insurance products offering acceptable coverage
    • Operated by each state (or HHS Secretary)
    • Up and running Jan. 1, 2014
    • No government-run “public option”
    • Exchange products available to uninsured individuals and small businesses
  • Premium subsidies on sliding scale for individuals up to 400% of FPL
Indian-specific Exchange features
  • Indian individuals are eligible to purchase coverage through Exchange
  • Monthly “window” for Indian enrollment in Exchange insurance plan
  • No cost-sharing for Indians up to 300% FPL
  • No Indian patient may be assessed cost sharing for services provided by I/T/U or CHS provider
  • HHS pays the cost of Indian cost-sharing protections
“Express Lane Agencies”
  • Public agencies that determine eligibility for income-based programs
    • E.g., Temporary Assistance for Needy Families (TANF)
  • States allowed (but not required) to rely on Express Lane Agency eligibility determinations for Medicaid, CHIP
    • Facilitate enrollment of kids in Medicaid, CHIP
  • IHS, tribes, tribal organizations, urban Indian organizations now have Express Lane Agency status
  • Effective March 23, 2010
Persons with Pre-Existing Conditions
  • Temporary program beginning in 2010
  • Make insurance coverage available to individuals –
    • Uninsured for 6 months or longer and
    • Who have pre-existing conditions
  • Ends in 2014 when the law’s consumer protections become effective
  • In Fall 2010, insurers ill be prohibited from denying coverage to kinds with pre-existing conditions
Individual Coverage Mandate
  • Objective: require all Americans to acquire some form of health insurance
    • Medicare, Medicaid, CHIP, private insurance
  • Enforced through tax penalties
  • Members of Federally-recognized Indian tribes are exempt from penalties
  • Individual Mandate requirement is being challenged in court by opponents
Tribally-provided Health Care Benefits
  • New law excludes value of health insurance and services provided to a tribal member by IHS or tribe from individual member’s gross income
  • Exclusion was high priority for Indian Country
    • IRS had said tribally-provided health insurance was taxable to individual tribal member
  • Effective March 23, 2010
  • “No inference” on whether such benefits provided prior to enactment are or are not excluded from member’s gross income
Indian Medicare Changes
  • Medicare Part B: Permanent authority for IHS, tribal programs to collect for all Part B services
    • Authority to collect for some Part B services expired Dec. 31, 2009
    • Effective retroactively to Jan. 1, 2010
  • Medicare Part D: Value of drugs dispensed by I/T/U pharmacy will count as if Indian patient paid for them
    • Corrects problem in original Medicare Part D law
    • Will enhance opportunities for I/T/U pharmacies to bill Part D drug plans
    • Effective Jan. 1, 2011
Payer of Last Resort
  • Puts in the law IHS’s regulation making IHS, tribal programs the payer of last resort
  • Impact: Any other insurance coverage carried by Indian patient is required to pay first
  • POLR rule now applicable to urban Indian organizations
  • Maximizes authority to collect third-party revenues
    • Medicare, Medicaid, CHIP, private insurance
Maternal + Child Home Visitation Program
  • New program for home visits to families with young children + expecting children who are at risk of poor maternal and child health
  • Federally-funded through grants to states
    • Funds already appropriated for 2010-2014
  • Tribes, tribal organizations, urban Indian organizations are eligible grantees
  • 3% of funds set-aside for Indian grants
    • Value of set-aside: $45 million over 5 years
Health Disparities Data Collection
  • HHS to collect data from Federal health programs by –
    • Race, ethnicity
    • Sex
    • Primary language
    • Disability status
  • Purpose: Monitor health disparity trends
  • Data will be collected from IHS programs
  • Tribal Epidemiology Centers are to be provided with health disparities analyses performed through this effort
Health Workforce Development
  • About ½ of the new law is devoted to health workforce development programs
  • Expansion of health workforce is vital to meet increased demand for care as more Americans acquire insurance coverage
  • IHS, tribes, tribal organizations, tribal public health agencies, urban Indian organizations eligible for many new programs
  • Most new programs will require appropriations
  • Watch for grant announcements