PPACA & Health Sector

General Provisions Affecting Multiple Sectors

PPACA and Private Insurance

  • Nondiscrimination Rules for Fully Insured Health Plans (Martindale). As of 2010, insurers can no longer deny or restrict coverage for children who have been diagnosed with an illness (that is, a preexisting condition). From 2014 on, all health plans will be prohibited from restricting coverage of preexisting conditions or charging higher premiums to individuals with health problems.
  • Pre-Existing Condition Insurance Plan.  From 2010 to 2014, a new, temporary  program will offer uninsured adults with preexisting conditions coverage in special state-based “pools.”
  • Medical Loss Ratio Requirements. On November 22, 2010, the Department of Health and Human Services released its interim final rule implementing the requirements of the new section 2718 of the Public Health Services Act (added by section 10101 of the Affordable Care Act), entitled, “Bringing Down the Cost of Health Care Coverage.”  This provision is usually referred to as the “medical loss ratio” (or MLR)  requirement, although the term “medical loss ratio” appears nowhere in section 2718. About two thirds of the stateshave required insurers to report their “anticipated loss ratio.”
  • Modification of Section 833 Treatment of Certain Health Organizations. The Affordable Care Act amended section 833 of the Code, which provides special rules for the taxation of Blue Cross and Blue Shield organizations and certain other organizations that provide health insurance. Interim guidance can be found in Notice 2010-79, which also solicits comments on the application of the amended provision.

PPACA and Hospitals

  • Additional Requirements for Tax-Exempt Hospitals. The Affordable Care Act adds requirements in the Internal Revenue Code that tax-exempt hospitals must meet to maintain their tax-exempt status. More information can be found in Notice 2010-39, which solicits written comments on the application of the new requirements. Comments must have been submitted by July 22, 2010.
  • Research and Analysis. How Will Hospitals be Affected by Health Care Reform? (Urban Institute)

PPACA and Physicians

PPACA and Pharmaceuticals

PPACA and Medical Devices

PPACA and Long Term Care


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