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Table 1 Key Affordable Care Act (ACA) Provisions Relevant to Older Adults with Multiple Chronic Conditions

From: Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update

Key ProvisionsEffective Implementation Date
Quality
 Improve care coordination for dual eligibles by creating a new office within the CMS services.March 2010
 Reduce Medicare payments to certain hospitals for hospital-acquired conditions by 1%.October 2015
 Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions.October 2012
 Provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.January 2011
Access
 Provide payments totaling $400 million in fiscal years 2011 and 2012 to qualifying hospitals in counties with the lowest quartile Medicare spending.January 2011
 Provide a 10% bonus payment to primary care physicians in Medicare from 2011 through 2015.January 2011
 Reduce Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and increase payments.October 2014
 Eliminate cost-sharing for Medicare covered preventive services and waive the Medicare deductible for colorectal cancer screening tests.January 2011
 Authorize Medicare coverage of annual personalized prevention plan services.January 2011
Cost
 Increase the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45 to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples.January 2013
 Restructure payments to Medicare Advantage (MA) plans by setting payments to different percentages of Medicare fee-for-service (FFS) rates.January 2011
 Establish an Independent Payment Advisory Board to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending.April 2013
Cost & Quality (Alternative Payment Models)
 Allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.January 2012
 Establish a hospital value-based purchasing program in Medicare to pay hospitals based on performance on quality measures.October 2012
 Establish a national Medicare pilot program to develop and evaluate paying a bundled payment.January 2013
 [Promote] patient-centered medical home models for high-need applicable individuals.January 2011
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