Sunday, August 2, 2009

Saturday, August 1, 2009

Division B - Medicare and Medicaid

This section on the changes to Medicare and Medicaid eat up pages 215 to page 855. The giant section is divided up as follows:
Title I - Improving Health Care Value
Subtitle A - Provisions related to Medicare Part A
Part 1 - Market Basket Updates
Part 2 - Other Medicare Part A provisions
Subtitle B - Provisions related to Part B
Part 1 - Physician's Services
Part 2 - Market Basket Updates
Part 3 - Other provisions
Subtitle C - Provisions related to Medicare Parts A and B
Subtitle D - Medicare Advantage reforms
Part 1 - Payment and Administration
Part 2 - Beneficiary Protections and Anti-Fraud
Part 3 - Treatment of Special Needs Plans
Subtitle E - Improvments to Medicare Part D
Subtitle F - Medicare Rural Access Protections

Title II - Medicare Beneificiary Improvements
Subtitle A - Improving and Simplifying Financial Assistance for Low Income Medicare beneficiaries
Subtitle B - Reducing Health Disparities
Subtitle C - Miscellaneous Improvements

Title III - Promoting primary care, mental health services and coordinated care

Title IV - Quality
Subtitle A - Comparative Effectiveness Research
Subtitle B - Nursing Home Transparency
Part 1 - Improving transparency of information on skilled nursing facilities and nursing facilities
Part 2 - Targeting enforcement
Part 3 - Improving staff training
Subtitle C - Quality measurements
Subtitle D - Physician payments sunshine provision
Subtitle E - Public reporting on health care-associated infections

Title V - Medicare Graduate Medical Education

Title VI - Program Integrity
Subtitle A - Increased funding to fight waste, fraud, and abuse
Subtitle B - Enhanced penalties for fraud and abuse
Subtitle C - Enhanced program and provider protections
Subtitle D - Access to information needed to prevent fraud, waste, and abuse

Title VII - Medicaid and CHIP
Subtitle A - Medicaid and health reform
Subtitle B - Prevention
Subtitle C - Access
Subtitle D - Coverage
Subtitle E - Financing
Subtitle F - Waste, Fraud, and Abuse
Subtitle G - Puerto Rico and the territories
Subtitle H - Miscellaneous

Title VIII - Revenue-related provisions

Title IX - Miscellaneous Provisions

It's going to be painful but I'm going to slog through it. The key is really understanding the current code, which of course I don't.

Title 4 - changes to tax code (sections 401-453)

OUCH.

If an individual does not belong to a qualifying plan (including VA, medicare, etc.), they get a 2.5% wallop on their modified adjusted gross income. The tax, however, can't exceed the average cost (premium) of a self-only basic plan offered by an Exchange plan.
There is a religious exemption for health coverage - interesting!

If an employer decides not follow along (good luck with that!) - an 8% tax on payroll wages.

For small businesses, the IRS code gets modified... —Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986. Wow, it is hard to read!

- the tax credit for SMB is based on 50% of their health coverage expenses
- the credit slides down as the expenses go over 20K
- no credit allowed for employees who get paid over 80K
- SMB means <=25 employees, where an employee makes at least 5K

Section 441 - more taxes!
1% for income between 350K-500K (after 2012, goes to 2%)
1.5% for 500K-1M (after 2012, goes to 3%)
5.4% over 1M (OUCH)

then we get... there will be a study done in 2012 for the years 2009-2019 to determine the reduction in federal expenditures based on Division B (medicare and medicaid changes) of this Act. If this report shows between 150B and 175B in savings over and above the 525B savings expected, the 1% tax above will no apply. If it's > 175B, then the 1.5% tax above does not apply either.

Section 452 appears to be unrelated to the healthcare code and is just a straight tax code change. It is listed as 'codification of economic substance doctrine'. This would seem VERY important, but I have no idea what it means. Any comments?