1. Implications for CDPHE Sara Russell Rodriguez Chronic Disease Director Colorado Department of Public Health and Environment

2.  Signed into law on March 23, 2010  Final bill created through a reconciliation process Could change items with fiscal impact No ability to change timelines  Timelines are aggressive  Many of the provisions in the bill have not had funding appropriated

3.  Effective July 6, 2010 in Colorado  Colorado runs plan (as opposed to HHS)  Eligibility Lawfully present in US Uninsured for the last 6 months Difficulty getting insurance due to a pre-existing condition

4.  Tax penalty $695-$2085 or 2.5% of family income Penalties are phased in  $95 in 2014  2.5% of income in 2016  Increases yearly with cost of living  Exemptions Religious Native American Those without coverage for less than 3 months Undocumented Incarcerated individuals

5.  Exemptions Premium exceeds 8% of income Income less than filing threshold  $9,350 for singles  $18,700 for couples

6.  Effective January 1, 2014  50+ employees with at least one full-time employee Penalties for those receiving subsidies for purchasing health insurance Must offer vouchers to those whose employer- based coverage is unaffordable  200+ employees Automatically enroll employees in coverage Employees can opt out

7.  Less than 50 employees are exempt from penalties  Employers with less than 25 employees receive tax credit for purchasing health insurance

8.  Effective January 1, 2014  All individuals under age 65  Up to 133% of the federal poverty level (FPL)  Financed through 100% federal funding for 2014-2016 Decreases incrementally to 90% in 2020  Increases provider payments for primary care to Medicare rates 100% federally financed

9.  Maintain current income eligibility  2015 states will receive a 23% increase in federal cost sharing  Children ineligible to enroll will receive tax credits in state exchanges

10.  Funding for innovative payment reform Accountable care collaboratives Rural telehealth Other pilots  Pilots for obesity prevention  Pilots for incentives for chronic disease prevention and management  Medical home incentives

11.  Requires tobacco cessation counseling and pharmacotherapy for pregnant women  Encourages no cost sharing for preventive benefits Receive additional federal funding  Waivers Family planning Long term care

12.  Payment reform Accountable care organizations Preventable admissions; conditions Reduce Medicare Disproportionate Share Hospital payments Independent payment advisory board  Independence at home pilot  New office for dual eligibles  Eliminates cost sharing for preventive benefits

13.  Exchanges need to be effective as of January 1, 2014  Individuals and small businesses (<100 employees) can purchase coverage  Offers subsidies for those up to 400% of FPL  Allows for catastrophic coverage for those <30 years old or exempt from individual mandate

14.  Allows coverage for dependent children up to age 26 (August 2010)  Requires reporting of funding spent on clinical rather than administrative costs Provides rebate to consumers if exceeds threshold (2011)  Prohibition of lifetime limits on coverage (August 2010)  Prohibition on annual limits (January 2014)

15.  Prohibit exclusion of pre-existing conditions in children (August 2010)  Prohibit exclusion of pre-existing conditions in adults (January 2014)  All proposed premium increases must be approved by the state

16.  US Preventive Services Task Force A and B Recommendations (Sept 2010) No cost sharing  Immunizations  Well-child care  Defines essential benefit package (2014) Limits on deductibles and co-pays  Plans can be “grandfathered” Exempt from coverage and cost sharing requirements

17.  Workforce development grants  National Health Service Corps  Training programs EIS, PHPS, laboratory, informatics Primary care Dental Long-term care  Loan Repayment Allied health professionals, public health, faculty

18.  Federally Qualified Health Centers $11 billion over 5 years  School-based health clinics Infrastructure  Nurse-managed health clinics  Surveillance and lab capacity  Meaningful Use Provider payments for Electronic Health Records

19.  Prevention and Wellness fund Tobacco, physical activity, nutrition, public health infrastructure  Healthy Aging Chronic Disease Self Management  Pregnancy Assistance Personal Responsibility  Community Transformation grants

20.  Immunizations  Home Visitation programs  Worksite wellness for small businesses 5 year grant funding available Permits employer-based rewards for behavior or outcomes  Menu labeling of chain restaurants and vending machines (2011)

21.  Patient navigation services  Diabetes Prevention Program  Accountable Care Organizations

22.  Community health teams  Workforce diversity  Data collection

23.  Interagency workgroup on quality measures National Improvement strategy  Comparative effectiveness research  National Prevention, Health Promotion and Public Health Council Chaired by Surgeon General National health promotion and prevention strategy

24.  Coverage of direct services Some will fall through the cracks  National direction Clear emphasis on primary prevention Funding for community-based initiatives

25.  Funding Opportunities Home Visitation Pregnancy prevention Immunizations Long term care Primary care Healthy Aging Prevention and Wellness Fund Patient navigation/community health worker Community transformation grants Dental sealants