HR 3200: Title I
Here's a quick summary (bulleted points) of the highlights of the first title of the bill.
*Sorry for some of the goofy margins and returns on this. I wrote it in wordpad while reading the bill and the format did not translate well into blogger.*
Pages 1-72:
First 14* pages definition of terms.
Title I (pages 1-72): Protections and Standards for Qualified Health Benefits Plans (QHBP)
Section 102: "Protecting the Choice to keep Current Coverage" (page 16).
Includes restrictions on premium increases during the "grandfather" period (page 17).
Subtitle B: Standards Guaranteeing Access to Affordable Coverage
Section 111: "Prohibiting Pre-Existing Condition Exclusion" (page 19).
People cannot be dropped for non-payment of premiums unless a specific course of consumer protection has been provided (page 20).
Individuals and families will all be charged a uniform rate (page 21).
Eighteen months after the date of the enactment of the legislation, a commission will provide Congress and applicable agencies a report on the study of factors affecting coverage (page 22): "To ensure that the law does not provide incentives for small and mid-size businesses to self-insure or create averse selection in the risk pools of large insurers and self-insured employers" (page 23).
Section 114: "Nondiscrimination in benefits: parity in mental health and substance abuse benefits" (page 23).
Section 115: Ensuring adequacy of provider networks; transparency in cost for in-network
and out-of-network benefits.
Premiums are to "be used for services" (page 25). *I need to study about the term "medical
loss ratio"; not sure what that means.
Subtitle C: Standards Guaranteeing Access to Essential Benefits (sets the bar for coverage for private insurers)
Choice of coverage (page 25)
Accordance with general medical standards (page 27)
No annual or lifetime limit on coverage
Is equivalent to average prevailing employer provided coverage
Minimum services to be covered:
Hospitalization (27)
Outpatient hospital, outpatient clinic, and emergency services (27)
Professional services of physicians and other health professionals (28) (they get
paid; it's not voluntary all of a sudden)
Services, equipment and supplies incident to the delivery of care (28)
Prescription drugs (28)
Rehabilitative and habilitative services (28)
Mental health and substance disorder services (28)
Preventive services (28)
MATERNITY CARE (28)
Well baby and well child care including oral health, vision, hearing etc. for children under
21 years of age
People who are using private insurance cannot pay more than $5,000/year out of pocket for
an individual; $10,000 per family
Section 123: Health benefits advisory committee (oversight)
Term limits for committee members (3 years)
Duties (pages 32-35)
Section 124: 45 day maximum for committee to review recommendations (keep 'em moving,
boys!)
18 months after enactment of legislation, initial standards for coverage will be set but will be
reviewed periodically (36).
Subtitle D: Additional Consumer Protections
Section 131: Requiring fair marketing practices by health insurers
Claims and appeals processes (37)
External review process (38)
Section 133: Requiring information transparency and plan disclosure (38) (no more fine print; no more quick changes to coverage, etc)
Subtitle E: Governance
Examination and Audits
Work with state regulatory agencies to terminate non-compliant plans (45)
Coordinating communication between state attorneys general (45) and all other overseeing
bodies
Subtitle F: Miscellaneous
Section 152: Prohibiting discrimination in health care (50)
Section 153: Whistle-blower protection (51)
Section 154: Collective bargaining shall not be restrained (53) (unions?)
Subtitle G: Early Investments
Competition (54)
Section 162: Ending health care rescission abuse (55) (fraud is the *only* exception for losing
coverage)
Third party review of rescission
Section 1173A: Standardize electronic administrative transactions
Including: Letting patient know the cost at point of service (58) (no sudden bills out of the blue)
Protection of data (62)
Section 164: Reinsurance program for retirees (65)
More tomorrow as time permits: we are painting at the new house tomorrow so I may not be able to update until the evening.
