Book description
A comprehensive reference guide interpreting and applying healthcare reform law for consultants, appraisers, accountants, and attorneys
The Financial Consultants'Guide to Healthcare Reform provides an historical backdrop on how the healthcare system got to its present state including the Massachusetts Reform and Medicare Advantage along with an explanation of the principal types of health insurance in the United States and how "insurance" actually works. A review and explanation of each of the reform provisions follows, including an analysis of what the implications are for providers, consumers and business and what responses each of these communities might have to the Reform. Using the authors' insights and firsthand experiences in U.S. healthcare finance, this book explains the new healthcare law for individuals and businesses alike, what to expect from it and what actions they need to take to comply.
Interprets and applies the health care reform law
Provides examples of what the impact of the law might look like
Extensive use of sidebars to provide in-depth analysis or background on particular topics of import, where the reader may need more detail to understand the context of Reform's changes.
Written for consultants, appraisers, accountants, and attorneys
Written by major figures in the world of healthcare valuation and consulting
The Financial Consultants' Guide to Healthcare Reform provides a complete handbook to healthcare reform for financial consultants, both for understanding this important legislation as well as for planning responses to it.
Table of contents
- Cover
- Series Page
- Title Page
- Copyright
- Foreword
- Preface
- Acknowledgments
- Chapter 1: Introduction
-
Chapter 2: Massachusetts
- The Time Line of Massachusetts Reform
- Early Reform Legislation in Massachusetts
- The Intervening Years
- Components of the 2006 Massachusetts Legislation
- Key Features of Massachusetts Reform
- Recounting the Results of Reform in Massachusetts
- Special Commission on the Health Care Payment System
- State Government Reports Tracking the Results of Reform
- Massachusetts Quarterly Reports
- Massachusetts Attorney General's Report
- Recent Legislative Changes through August 2010
- What Can We Learn from the Massachusetts Experience?
-
Chapter 3: Insurance Reforms
- What is Insurance?
- Components of Health Insurance and Healthcare Entitlement
- Health Insurers
- How Do Health Insurers Provide Health Insurance?
- Understanding Actuarial Risk
- How Does Self-Insurance Work?
- Regional and Industry Factors in Health Insurance
- The Reform of Health Insurance
- Minimum Essential Coverage
- Consumer Protection Provisions
- Grandfathered Health Insurance Plans
- Medical Loss Ratios
- Cost Containment
- Rating and Other Reforms in the Small Group and Individual Market
- Mini-Med Plans
- Insurance Exchanges
- The Massachusetts Experience
- Chapter Summary
- Appendix 3.1: Selected Legislative Text for Insurance Exchanges
- Appendix 3.2: CMS Proposed Regulations—Glossary of Health Insurance and Medical Terms
- Appendix 3.3: Using the Massachusetts Health Connector
-
Chapter 4: Medicare Advantage Plans
- How Many Medicare Beneficiaries are in Medicare Advantage Plans?
- Geographic Distribution of Medicare Advantage Enrollees
- History of Medicare Advantage and Its Predecessors
- Changes from the Reform
- Implications for the Provider Community
- Implications for Insurers
- Implications for Medicare Advantage Beneficiaries
- Appendix 4.1: PPACA Sections Affecting Medicare Advantage
-
Chapter 5: Medicaid Expansion
- Introduction and Overview
- Medicaid Enrollment and Spending
- Eligibility Changes
- Key Expansion Groups
- Community First Choice Option
- Benefits
- Financing the Changes
- Implications and Responses for Low-Income Uninsured and Taxpayers
- Appendix 5.1: Table of Medicaid Provisions in the PPACA
- Appendix 5.2: Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans
-
Chapter 6: Mandates, Subsidies, Penalties . . . and Taxes
- The Individual Mandate
- Subsidy Eligibility
- Tax Credits and Subsidies
- Subsidies
- Employer Requirements
- The Role of the Tax Code and the Internal Revenue Service
- Inexplicable Changes to Flexible Spending Accounts: Notices 2000–59 and 2011–5
- Itemized Deductions for Medical Expenses
- Reporting of Health Benefits on Form W-2
- Methods of Calculating the Cost of Coverage
- Health Insurance Information Provided by Employers to All Employees
- Annual Return to IRS on Coverage
- Tax Treatment of HealthCare Benefits Provided With Respect to Children Under Age 27: Notice 2010–38
- Tax Credit for Employee Health Insurance Expenses of Small Employers: Notices 2010–44 and 2010–82
- Consumer Operated and Oriented Plan (CO-OP Program)
- Funding of Patient-Centered Outcomes Research: Notice 2011–35
- Excise Tax on High-Cost Employer-Sponsored Health Coverage
- Added Medicare Tax on the Upper-Middle Class and High-Income Individuals
- Increased Medicare Part B Premium
- Increased Medicare Part D Premium
- Internal Revenue Code Changes for Tax-Exempt Hospitals
- Implications and Responses for Small Business
- Implications and Responses for Larger Business
- Implications and Responses for Individual Taxpayers and Consumers
- Some Thoughts for Lenders and Small-Business Investors
- Appendix 6.1: Table of Internal Revenue Service Notices
- Appendix 6.2: Table of Regulations (Treasury Decisions)
-
Chapter 7: Delivery System Reforms
- Overview of Delivery System Reforms
- Quality Measures
- Hospital Readmissions Reduction Program
- Payment Adjustments for Conditions Acquired in Hospitals
- Payment Bundling
- Revisions of Market Basket Updates and Incorporation of Productivity Improvements into Market Basket Updates
- Independent Payment Advisory Board
- Medicare Geographic Payment Disparities
- Medicare and Medicaid Disproportionate Share Hospital Payment Program
-
Chapter 8: Accountable Care Organizations
- Historical Parallels
- Precursor to ACOs: Physician Group Practice (PGP) Demonstration
- Center for Medicare and Medicaid Innovation
- The Proposed Regulations of March 31, 2011, and the Final Regulations of October 20, 2011
- Eligibility and Governance
- Agreement Requirement
- Primary Care Providers and the Assignment of Beneficiaries to the ACO
- Data Sharing
- Future Regulatory Changes
- Quality and Other Reporting Requirements
- Calculating the Performance Score for Each Measure within a Domain
- Shared Savings Determination
- Loss Factors Specific to the Two-Sided Model
- Claims Run-Out
- ACO Distribution of Shared Savings
- Public Reporting of Shared Savings
- Termination of the ACO Agreement
- Overlap with Other Shared Savings Initiatives
- Pioneer ACOs
- Advanced Payment ACO Model
- Antitrust Issues
- The Internal Revenue Service and ACOs
- Implications for Beneficiaries
- Implications for Providers
- Some Thoughts for Lenders and Small-Business Investors
- Chapter 9: Healthcare Workforce
-
Chapter 10: Transparency and Program Integrity
- Physician Ownership and Other Transparency
- Nursing Home and SNF Transparency
- Nationwide Background-Check Program
- Patient-Centered Outcomes Research
- Medicare, Medicaid, and CHIP Integrity Provisions
- Additional Medicaid Program Integrity Provisions
- Additional Program Integrity Provisions
- Elder Justice Act
- Healthcare Fraud Enforcement
- Chapter 11: Section 340B Expansion
- Chapter 12: Medical Tort Litigation Demonstration Program
- Chapter 13: Other Provisions
- About the Authors
- Index
Product information
- Title: The Financial Professional's Guide to Healthcare Reform
- Author(s):
- Release date: May 2012
- Publisher(s): Wiley
- ISBN: 9781118093221
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