PASSED 3/23/2010: HR 3590 Patient Protection+ Affordable Care Act

by NRSKarenRN NRSKarenRN, BSN, RN (Guide) Guide Expert Nurse

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience.

from kaiser family foundation:

side-by-side comparison of major health care reform proposals ...

read complete pending legislation:

hr 3200: america’s affordable health choices act of 2009

[color=#ffffff][color=#ffffff][color=#ffffff]senate finance committee america’s healthy future act of 2009



senate help committee affordable health choices act

the white house - health care reform

Edited by NRSKarenRN


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,335 Posts


nice timeline of major aspects of bill.

healthcare reform provisions kick in over 10 years


  • adults with pre-existing conditions who have been uninsured for at least six months can enroll in a temporary high risk health insurance pool and receive subsidized premiums--beginning three months after the bill's passage. (the pools expire when exchanges are implemented in 2014.)
  • all health insurance plans are to offer dependent coverage for children through age 26; insurers are prohibited from denying coverage to children because of pre existing health problems.
  • insurance companies can no longer put lifetime dollar limits on coverage and cancel policies--except in cases of fraud.
  • tax credits will be provided to help small businesses with 25 employees or fewer to get and keep coverage for these employees.
  • the medicare "doughnut hole," in which beneficiaries had to pay full cost of their prescription drugs, begins narrowing by providing a $250 rebate this year to those in the gap, which starts this year after they have spent $2,830. the doughnut hole fully closes by 2020.
  • indoor tanning has a 10% sales tax.


  • for medicare beneficiaries reaching the medicare doughnut hole, prescription coverage will be available with a 50% discount on brand name drugs.
  • a 10% medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
  • medicare advantage plans would begin to have their payments frozen—and then lowered in 2012. the plans would have to spend at least 85 cents out of every dollar on medical costs, while leaving 15 cents for plan operations, including overhead and salaries. reductions would be phased in over the next three to seven years.
  • a voluntary long term care insurance program would be made available to provide a modest cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. benefits would start five years after people begin paying a fee for coverage.
  • funding for community health centers would be increased to provide care for many low income and uninsured people.
  • employers would be required to report the value of healthcare benefits on employees' w 2 tax statements.
  • pharmaceutical manufacturers will have a $2.3 billion annual fee that will increase over time.

Edited by NRSKarenRN

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience. 3,156 Posts

changes which are very scary for some people...


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,335 Posts

Little talked items from bill that impacts home health agencies and PACE/LIFE programs for Seniors and those disabled.....along with Maternal Child resources

Subtitle E: New Options for States to Provide Long-Term Services and Supports - (Sec. 2401) Authorizes states to offer home and community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases.

(Sec. 2402) Gives states the option of:

(1) providing home and community-based services to individuals eligible for services under a waiver; and

(2) offering home and community-based services to specific, targeted populations

Creates an optional eligibility category to provide full Medicaid benefits to individuals receiving home and community-based services under a state plan amendment.

(Sec. 2403) Amends the Deficit Reduction Act of 2005 to: (1) extend through FY2016 the Money Follows the Person Rebalancing Demonstration; and (2) reduce to 90 days the institutional residency period.

(Sec. 2404) Applies Medicaid eligibility criteria to recipients of home and community-based services, during calendar 2014 through 2019, in such a way as to protect against spousal impoverishment.

(Sec. 2405) Makes appropriations for FY2010-FY2014 to the Secretary, acting through the Assistant Secretary for Aging, to expand state aging and disability resource centers.

(Sec. 2406) Expresses the sense of the Senate that:

(1) during the 111th session of Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need; and

(2) long-term services and supports should be made available in the community in addition to institutions.

Subtitle L: Maternal and Child Health Services - (Sec. 2951) Amends SSA title V (Maternal and Child Health Services) to direct the Secretary to make grants to eligible entities for early childhood home visitation programs. Makes appropriations for FY2010-FY2014.

(Sec. 2952) Encourages the Secretary to continue activities on postpartum depression or postpartum psychosis, including research to expand the understanding of their causes and treatment.

Authorizes the Secretary to make grants to eligible entities for projects to establish, operate, and coordinate effective and cost-efficient systems for the delivery of essential services to individuals with or at risk for postpartum conditions and their families. Authorizes appropriations for FY2010-FY2012.

(Sec. 2953, as modified by Sec. 10201) Directs the Secretary to allot funds to states to award grants to local organizations and other specified entities to carry out personal responsibility education programs to educate adolescents on both abstinence and contraception for the prevention of pregnancy and 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. 2955) Requires the case review system for children aging out of foster care and independent living programs to include information about the importance of having a health care power of attorney in transition planning.


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,335 Posts

Subtitle B: Innovations in the Health Care Workforce - (Sec. 5101, as modified by Sec. 10501) Establishes a National Health Care Workforce Commission to: (1) review current and projected health care workforce supply and demand; and (2) make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies...

Subtitle C: Increasing the Supply of the Health Care Workforce - (Sec. 5201) Revises student loan repayment provisions related to the length of service requirement for the primary health care loan repayment program.

(Sec. 5202) Increases maximum amount of loans made by schools of nursing to students.

(Sec. 5203) Directs the Secretary to establish and carry out a pediatric specialty loan repayment program.

(Sec. 5204) Requires the Secretary to establish the Public Health Workforce Loan Repayment Program to assure an adequate supply of public health professionals to eliminate critical public health workforce shortages in federal, state, local, and tribal public health agencies.

(Sec. 5205) Amends the Higher Education Act of 1965 to expand student loan forgiveness to include allied health professionals employed in public health agencies.

(Sec. 5206) Includes public health workforce loan repayment programs as permitted activities under a grant program to increase the number of individuals in the public health workforce.

Authorizes the Secretary to provide for scholarships for mid-career professionals in the public health and allied health workforce to receive additional training in the field of public health and allied health.

(Sec. 5207) Authorizes appropriations for the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program.

(Sec. 5208) Requires the Secretary to award grants for the cost of the operation of nurse-managed health clinics.

(Sec. 5209) Eliminates the cap on the number of commissioned officers in the Public Health Service Regular Corps.

(Sec. 5210) Revises the Regular Corps and the Reserve Corps (renamed the Ready Reserve Corps) in the Public Health Service. Sets forth the uses of the Ready Reserve Corps.

Subtitle D: Enhancing Health Care Workforce Education and Training - (Sec. 5301) Sets forth provisions providing for health care professional training programs.

(Sec. 5302) Requires the Secretary to award grants for new training opportunities for direct care workers who are employed in long-term care settings.

(Sec. 5305) Requires the Secretary to award grants or contracts to entities that operate a geriatric education center to offer short-term, intensive courses that focus on geriatrics, chronic care management, and long-term care.

Reauthorizes and revises the geriatric education programs to allow grant funds to be used for the establishment of traineeships for individuals who are preparing for advanced education nursing degrees in areas that specialize in the care of elderly populations.

(Sec. 5307) Authorizes the Secretary, acting through the Administrator of HRSA, to award grants, contracts, or cooperative agreements for the development, evaluation, and dissemination of research, demonstration projects, and model curricula for health professions training in cultural competency, prevention, public health proficiency, reducing health disparities, and working with individuals with disabilities.

(Sec. 5308) Requires nurse-midwifery programs, in order to be eligible for advanced education nursing grants, to have as their objective the education of midwives and to be accredited by the American College of Nurse-Midwives Accreditation Commission for Midwifery Education.

(Sec. 5309) Authorizes the Secretary to award grants or enter into contracts to enhance the nursing workforce by initiating and maintaining nurse retention programs.

(Sec. 5310) Makes nurse faculty at an accredited school of nursing eligible for the nursing education loan repayment program.

(Sec. 5311) Revises the nurse faculty loan repayment program, including to increase the amount of such loans.

Authorizes the Secretary, acting through the Administrator of HRSA, to enter into an agreement for the repayment of education loans in exchange for service as a member of a faculty at an accredited school of nursing.

(Sec. 5312) Authorizes appropriations for carrying out nursing workforce programs.

(Sec. 5313, as modified by Sec. 10501) Requires the Director of CDC to award grants to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.

Sec. 5316, as added by Sec. 10501) Requires the Secretary to establish a training demonstration program for family nurse practitioners to employ and provide one-year training for nurse practitioners serving as primary care providers in federally qualified health centers or nurse-managed health centers.


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,335 Posts

Subtitle E: Supporting the Existing Health Care Workforce - (Sec. 5401) Revises the allocation of funds to assist schools in supporting programs of excellence in health professions education for underrepresented minority individuals and schools designated as centers of excellence.

Authorizes appropriations for: (1) scholarships for disadvantaged students attending health professions or nursing schools; (2) loan repayment for health professions faculty; and (3) grants to health professions school to assist individuals from disadvantaged backgrounds.

(Sec. 5403) Requires the Secretary to: (1) make awards for area health education center programs; and (2) provide for timely dissemination of research findings using relevant resources.

(Sec. 5404) Makes revisions to the grant program to increase nursing education opportunities for individuals from disadvantaged backgrounds to include providing: (1) stipends for diploma or associate degree nurses to enter a bridge or degree completion program; (2) student scholarships or stipends for accelerated nursing degree programs; and (3) advanced education preparation.

(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.


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,335 Posts

Title VIII: Class Act - Community Living Assistance Services and Supports Act or the CLASS Act - (Sec. 8002, as modified by Sec. 10801)

Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program) under which:

(1) all employees are automatically enrolled, but are allowed to waive enrollment;

(2) payroll deductions pay monthly premiums; and

(3) benefits under a CLASS Independence Benefit Plan provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence and live in the community


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,335 Posts

subtitle h: provisions relating to title ix: (sec. 10901) revises provisions of or related to title ix of this act (as reflected in the summary of those provisions).

(sec. 10907) amends the internal revenue code to impose a 10% excise tax on any amount paid for indoor tanning services on or after july 1, 2010. exempts phototherapy services performed by a licensed medical professional from the definition of "indoor tanning services."

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