The Latest: During June, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA):

• The penalty provisions for individuals who do not purchase health insurance were found by the court to be within the federal government’s taxing power.
• The federal government can offer states additional funds under the ACA to expand the availability of health care under Medicaid, and require that states accepting such funds comply with the conditions on their use, but the court ruled that the federal government is not free to penalize states that choose not to participate in the Medicaid expansion by taking away their existing Medicaid funding.

As a result of the ruling, there have been questions raised by states regarding Medicaid expansion and establishment of state health insurance exchanges:

• Governor Corbett Letter to HHS Outlining Concerns Regarding Expansion (February 2013) 
• DPW Fact Sheet on Medicaid Expansion and Pennsylvania (February 2013)
• DPW Letter to HHS on Medicaid Expansion (August 2012)
• National Governor’s Association Letter (July 2012)
• HHS Secretary Sebelius’ Response to Governors (July 2012)
• National Association of Medicaid Directors Questions (July 2012)

Pennsylvania Implications: There are implications for Pennsylvania given the ruling:

• Pennsylvania will need to implement the health insurance exchange and consider whether to implement the Medicaid expansion as required by the ACA by 2014. The interrelationship of these two issues on the state’s uninsured population will need to be considered.
• Uncompensated care at hospitals has continued to increase, with the Pennsylvania Health Care Cost Containment Council reporting that, during fiscal year 2011, uncompensated care at the state’s acute care hospitals had reached $990 million.
• The Medicare and Medicaid hospital payment reductions and policy changes will proceed and are anticipated to reduce payments to Pennsylvania hospitals by $7 billion over a ten-year period.

Resources from HAP

• CMS FAQs on ACA Implementation Provides Answers to the Most Current Questions with a Focus on Medicaid (February 2013)
• HAP Summary: The Patient Protection and Affordable Care Act (ACA) of 2010 and the Health Care and Education Affordability Reconciliation Act (HCEARA) of 2010  - A detailed summary of key aspects of the law which impact hospitals.
• Timeline for Major Provisions in Health Care Reform Patient Protection and Affordable Care Act (Public Law 111-148) 2010-2014  - A detailed timeline for the next five years that outlines the implementation of major provisions by category.
• Healthcare.gov Implementation Center offers materials on implementing the Affordable Care Act, including an interactive map to select and view state specific activities and funding on health reform.
• State Legislative Tracking Database is intended to capture state actions related to the Affordable Care Act.

Health Care Delivery System Reform

Accountable Care Organizations (ACO)

• ACO Medicare Shared Savings Final Rule
• DOJ/FTC  Final Statement of Anti-Trust Enforcement Regarding ACOs
• The OIG Interim Final Rule on ACO Waivers
• The IRS Fact Sheet on ACOs

Health Information Technology Incentive Programs

• HAP Health IT Resource - Martin Ciccocioppo, HAP’s vice president, research, at (717) 564-9200
• Workflow Assessment for Health IT Toolkit - A new toolkit funded by AHRQ to assist small and medium sized practices with workflow analysis and redesign before, during, and after health IT implementation.
• Connecting America for Better Health: The Official CMS Website for the Medicare and Medicaid EHR Incentive Programs
  • Final Meaningful Use Rule (July 28, 2010)
  • Final Meaningful Use Criteria Rule (July 28, 2010)
• CMS State EHR Incentive Program Launch Times and HIT Websites Map
• Office of the National Coordinator for Health Information Technology (ONC) United States Department of Health and Human Services—Health Information Technology For the Future of Health and Care
• Final Temporary Certification Rule (June 24, 2010)
• The American Hospital Association -  Health IT - Meaningful Use Resources
• Pennsylvania Department of Public Welfare—Medical Assistance Health Information Technology Initiative
• Pennsylvania eHealth Collaborative
• Pennsylvania eHealth Initiative (PAeHI)
• Certification Commission for Health Information Technology (CCHIT)

Coverage Resources

• The Pre-Existing Condition Insurance Plan (PCIP) program helps people who have been locked out of the individual insurance market because of their health. The PCIP is a bridge program—only available until 2014—when new insurance rules go in to effect. A number of resources are available to promote the program:
  • The Pre-Existing Condition Insurance Plan—New Health Coverage Option for the Uninsured
  • About the New Pre-Existing Condition Insurance Plan
• Health Care Reform Coverage Expansion Payment Estimator - Spreadsheet to help model various scenarios for the value of coverage expansions under the federal health care reform law.
• Kaiser Family Foundation Summary of Coverage Provisions in the Patient Protection and Affordable Care Act

Grandfathered Health Plans

• Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans
• Questions and Answers: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans

PA Insurance Department

• PA Fair Care - Pennsylvania’s health plan for uninsured adults with pre-existing conditions
• PA Fair Care Fact Sheet

• Expand Medicaid in Pennsylvania: It's necessary to protect the health of Pennsylvania hospitals
  Op-Eds
• PA Hospitals Await Critical Medicaid Expansion Decision
  Op-Eds
• U.S. Supreme Court Decision on Affordable Care Act
  HAP Memo
• Statement from The Hospital & Healthsystem Association of Pennsylvania in Response to U.S. Supreme Court’s Affordable Care Act Decision
  News Release
• Pennsylvania Implications of Pending U.S. Supreme Court Ruling on the Affordable Care Act
  HAP Memo