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