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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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Federal Health 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.

• Requires the secretary to 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.

• Requires Medicare incentive 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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Federal Health 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.

• Authorizes the secretary to award grants to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs.

• Improve prevention by 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).

Topic

Indicator

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Federal Health Reform Crosswalk

Healthy Behavior

Proportion of the population engaged in healthy behaviors

1. PA 2: Increase the proportion of adults who meet current Federal physical activity guidelines for aerobic physical activity and for musclestrengthening activity.

2. NWS 10: Reduce the proportion of children and adolescents who are considered obese.

3. NWS 17: Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older.

4. SH 4: Increase the proportion of adults who get sufficient sleep.

• Requires the secretary to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span.

• Provide grants for up to 5 years to small employers that establish wellness programs (funds appropriated for 5 years beginning in fiscal year 2011).

• Provide technical assistance and other resources to evaluate employer-based wellness programs. Conduct a national worksite health policies and programs survey to assess employer-based health policies and programs (conduct study within 2 years following enactment).

• Permit employers to offer employees rewards in the form of premium discounts, waivers of cost-sharing requirements, or benefits that would otherwise not be provided—of up to 30% of the cost of coverage for participating in a wellness program and meeting certain health-related standards. Employers must offer an alternative standard for individuals for whom 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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Federal Health Reform Crosswalk

Chronic Disease

Prevalence and mortality of chronic disease

8. HDS 2: Reduce coronary heart disease deaths.

9. HDS 5: Reduce the proportion of persons in the population with hypertension.

10. C 1: Reduce the overall cancer death rate.

• 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 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

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Federal Health 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.

• Requires the secretary, 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.

• Requires the secretary to: (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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Federal Health Reform Crosswalk

Social Determinants

Proportion of the population experiencing a healthy social environment

1. 12. HC/HIT 1: (Developmental) Improve the health literacy of the population.

2. EMC 1: (Developmental) Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, socialemotional development, approaches to learning, language, and

• (Sec. 3501) Requires that research of the Center for Quality Improvement and Patient Safety be made “available to the public through multiple media and appropriate formats to reflect the varying needs of health care providers and consumers and diverse levels of health literacy.”

• (Sec. 3506) Authorizes a “program to update patient decision aids to assist health care providers and patients.” “Decision aids must reflect varying needs of consumers and diverse levels of health literacy.”

• (Section 3507) Directs the secretary to determine whether the addition of certain standardized information to prescription drug labeling and

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Federal Health Reform Crosswalk

Mental Health

Proportion of the population experiencing positive mental health

1. MHMD 4: Reduce the proportion of persons who experience major depressive episodes (MDE).

• (Sec. 5306) Authorizes the secretary to award grants to institutions of higher education to support the recruitment of students for, and education and clinical experience of the students in, social work 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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Federal Health 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

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Federal Health Reform Crosswalk

Substance Abuse

Proportion of the population engaged in substance abuse

1. SA 14: Reduce the proportion of persons engaging in binge drinking of alcoholic beverages.

2. SA 13: Reduce past-month use of illicit substances.

• (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)

Topic

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Federal Health Reform Crosswalk

Quality of Care

Proportion of the population receiving quality health care services

1. HA 1: Reduce central line-associated bloodstream infections (CLABSI).

• (Sec. 3508) Authorizes the secretary to award grants to eligible entities or consortia to carry out demonstration projects to develop and implement academic curricula that integrate quality improvement and patient safety in the clinical education of health professionals.