Appendix A
Health Reform Crosswalk: Patient Protection and Affordable Care Act

Topic

Indicator

Objective

Federal Health Reform Crosswalk

Access to Care

Proportion of the population with access to health care services

  1. AHS 1: Increase the proportion of persons with health insurance.

  2. AHS 3: Increase proportion of statepersons with a usual primary care provider.

  3. AHS 7: (Developmental) Increase the proportion of persons who receive appropriate evidence-based clinical preventive services.

  • Primary goal of federal health reform—projected to increase coverage to 32 million Americans through Medicaid expansion to 133% of federal poverty level (FPL) (16 million) and creation of statepersons based insurance exchanges (another 16 million).

  • Increase Medicaid payments in fee-for-service and managed care for primary care services provided by primary care doctors (family medicine, receive general internal medicine, or pediatric medicine) to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100% federal financing for the increased payment rates (effective January 1, 2013).

  • Provide a 10% bonus payment to primary care physicians in Medicare from 2011 through 2015. (Effective for 5 years beginning January 1, 2011).



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Appendix A Health Reform Crosswalk: Patient Protection and Affordable Care Act Federal Health Topic Indicator Objective Reform Crosswalk · Primary goal of federal health Access to Proportion 1. AHS 1: reform—projected to increase Care of the Increase the coverage to 32 million population proportion of Americans through Medicaid with persons with expansion to 133% of federal access to health insurance. poverty level (FPL) (16 health care 2. AHS 3: Increase million) and creation of state- services proportion of based insurance exchanges persons with a (another 16 million). usual primary · Increase Medicaid payments care provider. in fee-for-service and managed 3. AHS 7: care for primary care services (Developmental) provided by primary care Increase the doctors (family medicine, proportion of general internal medicine, or persons who receive pediatric medicine) to 100% appropriate of the Medicare payment rates evidence-based for 2013 and 2014. States will clinical preventive receive 100% federal financing services. for the increased payment rates (effective January 1, 2013). · Provide a 10% bonus payment to primary care physicians in Medicare from 2011 through 2015. (Effective for 5 years beginning January 1, 2011). continued 65

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66 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 Federal Health Topic Indicator Objective Reform Crosswalk · Sec. 3024) Directs the ( secretary to conduct a demonstration program to test a payment incentive and service delivery model that uses physician- and nurse practitioner-directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services (Sec. 5405, as modified by Sec. 10501). Requires the secretary, acting through the director of AHRQ, to establish a Primary Care Extension Program to provide support and assistance to educate primary care providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services, and evidence-based and evidence- informed therapies and techniques. · equires the secretary to R award grants to states for the establishment of Primary Care Extension Program State Hubs to coordinate state health care functions with quality improvement organizations and area health education centers. · equires Medicare incentive R payments to: (1) primary care practitioners providing primary care services on or after January 1, 2011, and before January 1, 2016; and (2) general surgeons performing major surgical procedures on or after January 1, 2011, and before January 1, 2016, in a health professional shortage area.

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67 APPENDIX A Federal Health Topic Indicator Objective Reform Crosswalk · Sec. 5503) Reallocates ( unused residency positions to qualifying hospitals for primary care residents for purposes of payments to hospitals for graduate medical education costs. · uthorizes the secretary to A award grants to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs. · mprove prevention by I covering only proven preventive services and eliminating cost sharing for preventive services in Medicare and Medicaid (effective January 1, 2011). For states that provide Medicaid coverage for and remove cost-sharing for preventive services recommended by the U.S. Preventive Services Task Force and recommended immunizations, provide a 1% increase in the Federal Medical Assistance Percentages (FMAP) for these services. Increase Medicare payments for certain preventive services to 100% of actual charges or fee schedule rates (effective January 1, 2011). Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women (effective 6 months following enactment). continued

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68 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 Federal Health Topic Indicator Objective Reform Crosswalk · Requires the secretary to Healthy Proportion of 4. PA 2: Increase provide for the planning and Behavior the population the proportion implementation of a national engaged in of adults who public-private partnership for a healthy meet current prevention and health behaviors Federal promotion outreach and physical education campaign to raise activity public awareness of health guidelines for improvement across the life aerobic physical span. activity and · Provide grants for up to 5 for muscle- years to small employers that strengthening establish wellness programs activity. (funds appropriated for 5 years 5. NWS 10: beginning in fiscal year 2011). Reduce the · Provide technical assistance proportion of and other resources to evaluate children and employer-based wellness adolescents programs. Conduct a national who are worksite health policies and considered programs survey to assess obese. employer-based health policies 6. NWS 17: and programs (conduct study Reduce within 2 years following consumption enactment). of calories · Permit employers to offer from solid employees rewards in the form fats and of premium discounts, waivers added sugars of cost-sharing requirements, in the or benefits that would population otherwise not be provided— aged 2 years of up to 30% of the cost of and older. coverage for participating 7. SH 4: Increase in a wellness program and the proportion meeting certain health-related of adults who standards. Employers must get sufficient offer an alternative standard sleep. or individuals for whom f it is unreasonably difficult or inadvisable to meet the standard. The reward limit may be increased to 50% of the cost of coverage if deemed appropriate (effective January 1, 2014). Establish 10-state pilot programs by July 2014 to permit participating states to apply similar

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69 APPENDIX A Federal Health Topic Indicator Objective Reform Crosswalk rewards for participating in wellness programs in the individual market and expand demonstrations in 2017 if effective. Require a report on the effectiveness and impact of wellness programs (report due 3 years following enactment). · equire chain restaurants R and food sold from vending machines to disclose the nutritional content of each item (proposed regulations issued within 1 year of enactment). · Requires the essential Chronic Prevalence 8. HDS 2: Reduce health benefits package Disease and mortality coronary heart to provide essential health of chronic disease deaths. benefits and limit cost disease 9. HDS 5: Reduce sharing. Directs the secretary the proportion to: (1) define essential health of persons in benefits and include emergency the population services, hospitalization, with maternity and newborn hypertension. care, mental health and 10. C 1: Reduce the substance use disorder overall cancer services, prescription drugs, death rate. preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care; (2) ensure that the scope of the essential health benefits is equal to the scope of benefits provided under a typical employer plan; and (3) provide notice and an opportunity for public comment in defining the essential health benefits. Establishes: (1) an annual limit on cost sharing beginning in 2014; and (2) a limitation on the deductible under a small group market health plan. · Sec. 3503) Directs the ( secretary, acting through the Patient Safety Research Center, to establish a continued

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70 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 Federal Health Topic Indicator Objective Reform Crosswalk program to provide grants or contracts to eligible entities to implement medication management services provided by licensed pharmacists, as a collaborative multidisciplinary, interprofessional approach to the treatment of chronic diseases for targeted individuals, to improve the quality of care, and reduce overall cost in the treatment of such disease. · equires the secretary, R acting through the director of CDC, to award grants to state and local governmental agencies and community- based organizations for the implementation, evaluation, and dissemination of evidence- based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence base of effective prevention programming. · equires the secretary to: R (1) conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries; and (2) evaluate community prevention and wellness programs that have demonstrated the potential to help Medicare beneficiaries reduce their risk of disease, disability, and injury by making healthy lifestyle choices. · Sec. 10413) Young Women’s ( Breast Health Education and

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71 APPENDIX A Federal Health Topic Indicator Objective Reform Crosswalk Awareness Requires Learning Young Act of 2009, or the EARLY Act, requires the secretary, acting through the director of CDC, to conduct: (1) a national education campaign to increase awareness of young women’s knowledge regarding breast health and breast cancer; (2) an education campaign among physicians and other health care professionals to increase awareness of breast health of young women; and (3) prevention research on breast cancer in younger women. · (Sec. 10323) Amends SSA Environmental Proportion of 11. EH 1: Reduce title XVIII (Medicare) to deem Determinants the population the number eligible for Medicare coverage experiencing a of days the certain individuals exposed to healthy Air Quality environmental health hazards. physical Index (AQI) environment exceeds 100. · (Sec. 3501) Requires that Proportion of 12. HC/HIT 1: Social (Developmental) research of the AHRQ’s Determinants the population Improve the Center for Quality experiencing a health literacy Improvement and Patient healthy social of the Safety be made “available to environment population. the public through multiple 13. EMC 1: media and appropriate formats (Developmental) to reflect the varying needs of Increase the health care providers and proportion of consumers and diverse levels children who of health literacy.” · (Sec. 3506) Authorizes are ready for school in all a “program to update patient five domains decision aids to assist health of healthy care providers and patients.” development: “Decision aids must reflect physical varying needs of consumers development, and diverse levels of health social- literacy.” · (Section 3507) Directs emotional development, the secretary to determine approaches to whether the addition of certain learning, standardized information to language, and prescription drug labeling and continued

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72 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 Federal Health Topic Indicator Objective Reform Crosswalk cognitive print advertising would development. improve health care decision 14. AH 5: Increase making by clinicians and educational patients and consumers; to achievement of consider scientific evidence on adolescents and decision making; and to onsult with various young adults. c stakeholders and “experts in health literacy.” · Sec. 5301) Preference for ( training grant awards in the medical specialties are for qualified applicants that “provide training in enhanced communication with patients and in cultural competence and health literacy.” Injury Proportion of 15. IVP 1: Reduce the fatal and population nonfatal injuries. that experiences injury · (Sec. 5306) Authorizes the Mental Health Proportion of 16. MHMD 4: secretary to award grants to the Reduce the institutions of higher education population proportion of to support the recruitment of experiencing persons who students for, and education and positive experience clinical experience of the mental health major depressive students in, social work episodes (MDE). programs, psychology programs, child and adolescent mental health, and training of paraprofessional child and adolescent mental health workers. · Sec. 5604) Authorizes the ( secretary, acting through the administrator of the Substance Abuse and Mental Health Services Administration, to award grants and cooperative agreements for demonstration projects for the provision of coordinated and integrated services to special populations through the colocation of primary and specialty care

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73 APPENDIX A Federal Health Topic Indicator Objective Reform Crosswalk services in community-based mental and behavioral health settings. · Sec. 10410) Establishing a ( Network of Health-Advancing National Centers of Excellence for Depression Act of 2009, or the ENHANCED Act of 2009, requires the secretary, acting through the administrator of the Substance Abuse and Mental Health Services Administration, to: (1) award grants to establish national centers of excellence for depression; and (2) designate one such center as a coordinating center. Requires the coordinating center to establish and maintain a national, publicly available database to improve prevention programs, evidence-based interventions, and disease management programs for depressive disorders using data collected from the national centers. · Sec. 1302, as modified by ( Sec. 10104) Requires the essential health benefits package to provide essential health benefits and limit cost sharing. Directs the secretary to: (1) define essential health benefits and include emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care; (2) ensure that the scope of the essential health benefits is equal to the scope of benefits continued

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74 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 Federal Health Topic Indicator Objective Reform Crosswalk provided under a typical employer plan; and (3) provide notice and an opportunity for public comment in defining the essential health benefits. Establishes: (1) an annual limit on cost sharing beginning in 2014; and (2) a limitation on the deductible under a small group market health plan. Maternal Proportion of 17. MICH 8: Reduce and Infant healthy births low birth weight Health (LBW) and very low birth weight (VLBW). · (Sec. 2953, as modified Responsible Proportion of 18. FP 8: Reduce by Sec. 10201) Directs the Sexual the population pregnancy rates secretary to allot funds Behavior engaged in among to states to award grants to responsible adolescent local organizations and sexual females. other specified entities to carry behavior 19. HIV 17: Increase out personal responsibility the proportion education programs to educate of sexually adolescents on both abstinence active persons and contraception for the who use prevention of pregnancy and condoms. sexually transmitted infections, as well as on certain adulthood preparation subjects. Makes appropriations for FY2010– FY2014. · Sec. 2954) Makes ( appropriations for FY2010– FY2014 for abstinence education. · (Sec. 10410) Establishing a Substance Proportion of 20. SA 14: Reduce Network of Health-Advancing Abuse the population the proportion National Centers of Excellence engaged in of persons for Depression Act of 2009, substance engaging in or the ENHANCED Act of abuse binge drinking 2009, requires the secretary, of alcoholic acting through the beverages. administrator of the Substance 21. SA 13: Reduce Abuse and Mental Health past-month use Services Administration, to: of illicit (1) award grants to establish substances. national centers of excellence for depression; and (2)

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75 APPENDIX A Federal Health Topic Indicator Objective Reform Crosswalk designate one such center as a coordinating center. Requires the coordinating center to establish and maintain a national, publicly available database to improve prevention programs, evidence-based interventions, and disease management programs for depressive disorders using data collected from the national centers. · (Sec. 1201, as modified Tobacco Proportion of 22. TU 1: Reduce by Sec. 10103) Prohibits a the population tobacco use health plan (“health plan” using tobacco by adults. under this subtitle excludes 23. TU 3: Reduce any “grandfathered health the initiation of plan” as defined in section tobacco use 1251) from: (1) imposing any among children, preexisting condition adolescents, and exclusion; or (2) young adults. discriminating on the basis of any health status-related factor. Allows premium rates to vary only by individual or family coverage, rating area, age, or tobacco use. · Sec. 4107) Provides ( for Medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use by pregnant women. · (Sec. 3508) Authorizes the Quality Proportion of 24. HA 1: Reduce secretary to award grants to of Care the population central line- eligible entities or consortia to receiving associated carry out demonstration quality health bloodstream projects to develop and care services infections implement academic curricula (CLABSI). that integrate quality improvement and patient safety in the clinical education of health professionals.

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