Orange County NC Website
DETAILED SUMMARY OF AFFORDABLE HEALTH CARE FOR AMERICA ACT <br />and cannot mandate participation nor use participation as a condition to receive any financial <br />incentive. <br />MEDICAID <br />(provisions relating to Health Care Reform are above) <br />Preventive services. Requires State Medicaid programs to cover recommended preventive services <br />without cost-sharing. States will receive their regular federal matching rate for the cost of these <br />services. <br />Payments for primary care services. Requires that physicians and other practitioners are paid for <br />primary care services they provide to Medicaid patients at 100 percent of Medicare rates beginning in <br />2012. The federal government will pay 100 percent of the increased costs in 2012 through 2014, 90 <br />percent thereafter. <br />Additional federal funds to states with high unemployment. Assists States in maintaining access to <br />Medicaid services during the recession by extending the current Recovery Act increase in federal <br />Medicaid payments to states with high unemployment rates. <br />Coverage for HIV-positive individuals. Allows State Medicaid programs to cover low-income <br />individuals who are HIV positive through December 31, 2013, after which coverage will be available <br />through the Health Insurance Exchange or, for those with incomes at or below 133 percent of poverty, <br />Medicaid. States would receive the enhanced federal matching rate for these costs. <br />Nurse home visitation. Allows State Medicaid programs to cover nurse home visitation services for <br />first-time pregnant women and mothers with children under 2. The federal government would match <br />these costs at the state's regular rate. <br />Increasing prescription drug rebates. Increases the minimum percentage rebate on brand-name drugs <br />to 23.1 percent of average manufacturer price; extends rebates to new formulations of brand-name <br />drugs; and extends rebate requirement to drugs prescribed by Medicaid managed care organizations. <br />Reductions in Medicaid DSH payments. Directs the Secretary of HHS to reduce Medicaid DSH <br />payments to States by a total of $10 billion ($1.5 billion in FY 2017, $2.5 billion in FY 2018, and $6.0 <br />billion in FY 2019) using a methodology that imposes the largest reductions on states with the lowest <br />percentages of uninsured individuals or the least effective targeting of funds on DSH hospitals. <br />Payments to pharmacists. Increases the ceiling on payments for generic drugs to 130 percent of the <br />weighted average of monthly average manufacturer prices. <br />Medical home pilot program. Establishes a 5-year pilot program to evaluate medical home models for <br />beneficiaries including medically fragile children. A total of $1.235 billion is made available for <br />increased federal matching for administrative costs. <br />Managed care organizations. Requires that Medicaid MCOs meet a medical loss ratio standard set by <br />the Secretary of HHS at not less than 85 percent. <br />Prepared by the Committees on Ways & Means, Energy & Commerce, and Education & tabor 9 <br />October 29, 2009 <br />32 <br />