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Affordable Care Act Nurse Practitioner Association of Southwestern Pennsylvania May 15, 2013

H EALTH C ARE.GOV. Affordable Care Act Nurse Practitioner Association of Southwestern Pennsylvania May 15, 2013. Aryanna Abouzari, Esq. Executive Officer U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia.

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Affordable Care Act Nurse Practitioner Association of Southwestern Pennsylvania May 15, 2013

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  1. HEALTHCARE.GOV Affordable Care ActNurse Practitioner Association of Southwestern Pennsylvania May 15, 2013 Aryanna Abouzari, Esq. Executive Officer U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia

  2. Critical Need for Health Reform 48.6 million uninsured Americans $3 trillion spent annually on healthcare 17.9 % of our economic output tied up in the health care system Without reform, by 2040, 1/3 of economic output tied up in health care

  3. Affordable Care Act Overview • Creates Consumer Protections • Prevents denials of coverage for pre-existing conditions • Make health insurance more affordable for middle class families and small businesses with tax credits • Expands access to care through Marketplaces and Medicaid expansion

  4. Highlights for Providers • Increases the number of Primary Care Practitioners – Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants • Projected to place more than 16,000 health professionals over next 5 years • Community Health Centers - Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years • 231 community health centers in PA eligible for funding • 671,646 patients treated in 2010 at federally supported health centers in the U.S.

  5. Highlights for Nursing Workforce Nurse Education, Practice, Quality & Retention Nursing Workforce Diversity Nurse Faculty Loan Program Advanced Nursing Education Program Advanced Education Nursing Traineeships Nurse Anesthetist Traineeships

  6. Center for Medicare and Medicaid Innovation • Developing payment and delivery system reforms, focused on: • Expanding team-based care coordination • Rewarding providers for care outside of traditional face-to-face visits • Focusing on aggressive management of chronically ill patients • Expanding access to home-based care • $10 billion in funding for FY 2011 - 2019 • Opportunity to scale up: authority to expand successful models to the national level

  7. Center for Medicare and Medicaid Innovation Partnership for Patients Accountable Care Organizations Bundled Payments for Care Improvement Community-based Care Transitions Program Value Based Purchasing Graduate Nurse Education Demonstration

  8. Health Insurance Marketplace • Sometimes called “Exchanges,” the Marketplace is required by the ACA to be created by January 1, 2014 • New “marketplace” where small businesses and individuals can select and enroll in a private health insurance plan • Consumers will have • the same level of benefits and coverage available to members of Congress • more choice and selection in health plans

  9. Marketplace Implementation • Three models available • State-Based • Federal-State Partnership • Federally-Facilitated • States can apply for Marketplace establishment funding at any time and be awarded grants through 2014 • HHS to operate marketplaces for States that have not elected to do so

  10. Health Insurance Marketplace Regional Snapshot • PA– No enabling legislation; Federally-facilitated • DE – No enabling legislation; Federal-State Partnership • MD – Passed enabling legislation; State-based • DC – Passed enabling legislation; State-based • WV – Passed enabling legislation; Federal-State Partnership • VA – No enabling legislation; Federally-facilitated

  11. Financial Assistance • Premium tax credits • Will reduce the premium amount the consumer owes each month • Available to eligible consumers with household incomes between 100% and 400% of the FPL ($44,680 for an individual and $92,200 for a family of 4 in 2012), and who don’t qualify for other health insurance coverage • Based on household income and family size for the taxable year • Paid each month to the insurer

  12. Financial Assistance • Cost-sharing reductions: • Reduce out-of-pocket costs (deductibles, coinsurance, copayments) • Generally available to those with income 250% FPL or below ($27,925 for an individual and $57,625 for a family of 4 in 2012) • Consumer must enroll in a “silver-level” plan

  13. Quality Insurance • The ACA requires plans inside the Marketplace to meet particular actuarial value (AV) targets • Bronze = 60% AV • Silver = 70% AV • Gold = 80% AV • Platinum = 90% AV • “Metal Levels” will enable consumers to compare plans with similar levels of coverage, promote competition on premiums, and allow plans flexibility to design cost sharing structures

  14. Quality Insurance • Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services/devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

  15. Enrollment Process • Consumer submits application to the marketplace • Online • Phone • Mail • In Person • The marketplace verifies and determines eligibility for • enrollment in a Qualified Health Plan (QHP) • tax credits and cost-sharing reductions • Medicaid or CHIP • Consumer enrolls in a QHP or Medicaid/CHIP • Online plan comparison tool available to inform health plan choice • Tax credit is sent to insurer (if eligible) to reduce consumer premium owed

  16. Enrollment Assistance • Help available in each Marketplace • Toll-free call center • Website • Navigator program • Certified Application Counselors • Community-based organizations • Agents and brokers

  17. Initial Open Enrollment Period • October 1, 2013 – March 31, 2014

  18. Affordable Care Act website –www.healthcare.gov Health Insurance Marketplace – marketplace.cms.gov Center for Consumer Information & Insurance Oversight website – http://cciio.cms.gov Affordable Care Act Spanish website – www.cuidadodesalud.gov Resources:

  19. Thank you! Contact: aryanna.abouzari@hhs.gov

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