The Senate Health, Education, Labor, and Pensions (HELP) Committee released its version of a health reform bill known as The Affordable Health Choices Act. Under the bill: i) no individual can be denied health coverage because of a preexisting medical condition; ii) there would be no annual or lifetime limits on health coverage; and iii) preventive care would receive greater funding. Here is a summary of some of the significant portions of the bill provided by the HELP committee:
Prohibiting Discrimination Based on Health Status. In issuing health insurance policies, insurers will not be permitted to establish terms of coverage based on any applicant's health status, medical condition (including physical and mental illness), claims experience, prior receipt of health care, medical history, genetic information, evidence of insurability (such as being a victim of domestic violence) or disability. (§ 2706)
Ensuring the Quality of Care. Health insurance policies will be required to include financial incentives to reward the provision of high-quality care that includes case management, care coordination, chronic disease management, wellness and health promotion activities, child health measures, activities to improve patient safety and reduce medical errors, as well as culturally and linguistically appropriate care. (§ 2707)
Coverage of Preventive Health Services. Health insurance policies will not be allowed to impose more than minimal cost sharing for certain preventive services endorsed by the U.S. Preventive Services Task Force as clinically and cost effective, for immunizations recommended by the CDC and for certain child preventive services recommended by the Health Resources and Services Administration. (§ 2708)
Extension of Dependent Adults. All individual and group coverage policies will be required to continue offering dependent coverage for children until the child turns age 26, according to regulations to be established by the Secretary of Health & Human Services. (§ 2709)
No Lifetime or Annual Limits. No individual or group health insurance policy will be permitted to establish lifetime or annual limits on the dollar value of benefits for any enrollee or beneficiary. (§ 2710)
Notification by Plans Not Providing Minimum Qualifying Coverage. Health plans that fail to provide minimum qualifying coverage shall notify enrollees prior to enrollment or re-enrollment, according to regulations to be established by the Secretary of Health & Human Services. (§ 2711)
Promotion of Choice of Health Insurance. The Secretary will develop standards for Gateway plans to provide summaries of benefits in a standard format. Also prohibits rescission of coverage after plan issue and provides grants to States to establish health insurance customer assistance.
Prohibition of Discrimination Based on Salary. Health insurers will not be permitted to limit eligibility based on the wages or salaries of employees. (§ 2719) Community Health Insurance Option. The Secretary will establish a community health insurance option that complies with the health plan requirements established by this title and provides only the essential health benefits established in section 3103, except in states that offer additional benefits. There are no requirements that health care providers participate in the plan or that individuals join the plan. The premiums must be sufficient to cover the plan's cost. The Secretary shall negotiate rates for provider reimbursement. Reimbursement rates will be negotiated by the Secretary and shall not be higher than the average of all Gateway reimbursement rates. A "Health Benefit Plan Startup Trust Fund" will be created to provide loans for the initial operations of the community health insurance plan, which the plan will be r equired to pay back no later than 10 years after the payment is made. After the first 90 days of operation, the community health plan will be subject to a Federal solvency standard, established by the Secretary, and will be required to have a reserve fund that is at least equal to the dollar value of incurred claims. Each state will establish a State Advisory Council to provide recommendations to the Secretary on the policies and procedures of the community health insurance plan. (§ 3105)
Health Care Delivery System Research; Quality Improvement Technical Assistance. A Patient Safety Research Center is established in the Agency for Healthcare Research and Quality (AHRQ). In addition to supporting research, technical assistance and process implementation, grants will be made to local providers to teach and implement best practices. Best practices help deliver care safely. The Patient Safety Research Center will strengthen best practice research and dissemination. Creating grants to identify and disseminate best practices to local providers will prevent medical errors and reduce their associated costs. (§ 211) You can access more information here.