The Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (H.R. 3590) instituted changes that have drastically changed our health care system. Health care reform legislation included many new and innovative mechanisms that were designed to increase the number of insured individuals and deliver high quality care while lowering the cost of coverage. Several of these ideas include the creation of state based insurance exchanges, the elimination of life time caps and pre-existing condition discrimination, a mandate requiring all individuals purchase health insurance, and tax credits for low income individuals to purchase health insurance.
Primary Care Provisions
Also included in the health care reform legislation were many provisions specifically affecting primary care and primary care educators. Listed below are brief summaries of some of these provisions and links to the specific bill text.
Reauthorizes Title VII Section 747 primary care medicine training and includes a new focus on Patient Centered Medical Homes, etc. Appropriation levels were authorized for $125 million in FY 2010 and such sums as necessary for FY 2011-2014.
Title VII Funding language can be seen here.
Legislation establishes a grant program to help medical schools recruit students most likely to practice medicine in underserved rural communities, provide rural-focused training and experience, and increase the number of medical graduates who practice in underserved rural communities. Authorizes $4 million for each of the fiscal years 2010-2013.
Rural Physician Training Grants language can be seen here.
Establishes a Primary Care Extension program through AHRQ that will support and assist primary care providers with the dissemination and implementation of innovations and best practices to improve community health. State/ Multi-state Hubs and local extension programs would be created to administer the program. $120 million is authorized in FY 2011 and FY 2012 and as much as necessary in FY 2013 and FY 2014. Extension Programs would also be eligible to apply for AHRQ technical assistance grants and medication management grants in collaboration with eligible entities.
The Primary Care Extension Program language can be seen here.
Allows the Secretary to award grants to THCs (community based ambulatory patient care centers that operate a primary care residency program; listed as FQHC, rural health clinic, community mental health center, health center operated by Indian Health Service, or a center receiving Title X grants) to establish new accredited or expanded primary care residency programs. These would be considered planning grants. Authorized funds equal $25 million for FY 2010 and $50 million for FY 2011-12. Operating funds would be established through a mandatory appropriations trust fund equal to $230 million over five years. Payment is only for expansion -- funding for residents above a base level -- or establishment of newly accredited programs. Funding is only to programs where the teaching health center is the institutional sponsor of the residency program. Allows up to 50% fulfillment of NHSC service obligation time through clinical teaching at Teaching Health Centers.
Teaching Health Center language can be seen here.
Modifies DGME and IME funding to count costs incurred at non-hospital settings including a non-hospital training (Volunteer Preceptor) fix, didactic training, vacation, sick or other approved leave. Legislation removes the 90% rule. Also when a hospital closes, its residency positions will be distributed to other hospitals. The statute contains a priority order for the distribution.
The Volunteer Preceptor, Didactic Fix, and Slot Distribution language can be seen here.
A hospital that hasn’t filled its positions up to it's cap (measured from the highest level from the 3 most recent years) will be reduced by 65% of the difference between filled positions and the cap. There are exceptions that allow a hospital to retain its unfilled positions, including a hospital in a rural area with fewer than 250 beds or a hospital that already underwent voluntary cap reduction. Hospitals that are given an increase in their cap (additional slots) must:1) maintain the average number of primary care residents that they had during the past three years and use 75% of the new slots for primary care or general surgery. Distribution shall be based on the following three factors:70% of positions go to fill the first category --1) Located in a state with a resident-to-population ratio in the lowest quartile (which means less teaching hospitals in the state compared to the population size). 30% of positions go to fill the next two categories. 2) Located in the “top ten” of areas (states, territories or DC) with highest ratio of population living in health professional shortage areas compared to total population of the area 3) Located in a rural area.
The GME Slot Redistribution language can be seen here.
Allows for a 10% primary care bonus payment of Medicare payments for primary care practitioners on services furnished on or after Jan. 1, 2011 and before Jan. 1 2016. Primary Care practitioners include primary care physicians, nurse practitioners, clinical nurse specialist, physician assistant, or individual for whom at least 60% of allowed charges were primary care services. Primary care services are defined by the Secretary as codes 99201 through 99215, 99304 through 99340, and 99341 through 99350.
The Primary Care Bonus Payment legislation can be seen here.