Agenda - 10-12-2010 - Board of Health Meeting

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DETAILED SUMMARY OF AFFORDABLE HEALTH CARE FOR AMERICA ACT Part B premium clarification. Allows capital gains from the sale of a primary residence to count as a life-changing event for purposes of using a more recent tax year for determination of the Part B income-related premium so that the use of a nest egg doesn't increase the Part B premium owed. Durable medical equipment in Medicare. Provides protections for beneficiaries receiving oxygen therapy in the event an oxygen supplier goes out of business. Exempts certain pharmacies from the surety bond requirement and the need to be accredited to sell diabetic testing supplies and certain other items. Payment for imaging services. Instructs CMS to pay more accurately for imaging services in Medicare. Excludes low-tech imaging devices (such as ultrasound, mammograms, EKGs, and x-rays) from the adjustment in payment. Pa rts C & D: Medicare Advantage payment. Beginning in 2011, reduces MA payments over three years to achieve parity with 100 percent FFS rates; provides targeted bonuses tohigh-quality plans in high-enrollment areas where reductions likely to be most disruptive. Medicare Advantage reforms. Changes the annual enrollment period for beneficiaries to enroll in Medicare Advantage to November 1-December 15. Medicare Advantage administrative costs and consumer protections. Beginning in 2014, requires MA plans to maintain medical loss ratios of at least 85 percent, ensuring that payments to plans are predominantly spent on providing healthcare, not overhead and profit. Limits Medicare Advantage cost-sharing to no greater than cost-sharing in traditional Medicare. Medicare drug benefit. Eliminates Part D donut hole over time and provides 50 percent discount in donut hole for Part D enrollees. Restores manufacturer rebate for Part D drugs used by dual eligibles, as well as low-income subsidy eligibles after 2015. Funds raised by this provision are used to close the Part D donut hole. Medicare low-income subsidy. Increases eligibility limits by raising assets test and clarifying what counts toward the asset test. Eliminates cost-sharing for certain non-institutionalized dual eligibles. Encourage accurate dispensing of drugs. Requires that Part D and MA-PD plans develop methods to reduce waste of drugs in the long-term care setting. Increase use of generics. Increases generic drug utilization by eliminating current requirements that prevent Part D and MA-PD plans from creating incentives for seniors to use lower-cost generic drugs. Other: Follow-on biologics. Creates an FDA licensure pathway for "biosimilar" generic biological products, allowing these products to come to market and compete with brand name biologics. The Prepared by the Committees on Ways & Means, Energy & Commerce, and Education & Labor 7 October 29, 2009 30