Number: 111- 40
Date: March 24, 2010

On March 23, 2010, President Obama signed H.R. 3590, the “Patient Protection and Affordable Care Act,” which became Public Law Number 111-148. The House cleared the Senate-passed version of the bill on March 21, 2010, by a vote of 219-212, (see Legislative Bulletin 111-31 ) which describes the Senate-passed provisions.

During the March 21 st session, the House also passed H.R. 4872, the “Health Care and Education Reconciliation Act of 2010,” by a vote of 220 to 211. The bill contains a number of revisions and additions to H.R. 3590, and has been sent to the Senate for consideration.

Provisions of interest to SSA in P.L.111-148 are described below. Provisions requiring immediate implementation efforts by SSA are indicated by an asterisk (*). Changes to those provisions that would be made under H.R. 4872 are identified and shown in bold type, while new provisions of interest in H.R. 4872 are described last.

HEALTH INSURANCE EXCHANGE AND AFFORDABILITY TAX CREDITS

State Exchanges and Marketing Requirements – Enrollment

•  Requires each State to establish an “American Health Benefit Exchange” to facilitate the purchase of qualified health plans for individuals and employees of small businesses.

•  Requires the Secretary of Health and Human Services (HHS) to establish a system under which residents of each State may apply for certain needs-based programs using a single, streamlined form filed with the State Exchange or with State officials operating other State health subsidy programs. Such applications may be filed online, in person, by mail, or over the phone.

•  Requires the Secretary of HHS to establish an initial enrollment period, an annual enrollment period, and certain other enrollment periods for specific groups.

•  Requires the Exchanges to begin January 1, 2014.

Health Care Affordability Tax Credits – Eligibility

Citizenship Status Verification

•  Requires the Exchanges, for purposes of preventing illegal immigrants from participating in an Exchange and obtaining premium tax credits and reduced cost sharing, to submit an applicant's name, SSN, date of birth, and attestation of U.S. citizenship to the Secretary of HHS, who would, in turn, submit the information to SSA.

•  Requires SSA to determine whether an applicant's name, SSN, date of birth, and allegation of U.S. citizenship are consistent with SSA records and report such determination to the Secretary of HHS.

•  Requires the Secretary of HHS to verify citizenship with the Department of Homeland Security (DHS), upon notification from SSA that it cannot confirm citizenship.

•  Requires such determinations to be made through the use of an online or electronic system developed by the Secretary of HHS, in consultation the Commissioner and DHS.

•  Requires, for any applicant whose claim of U.S. citizenship cannot be verified, the use of the citizenship verification procedures specified in section 1902(ee) of the Social Security Act. Such verification procedures require the State to make a reasonable effort to identify and address the causes of the inconsistent information and, after such efforts are made, the State must allow the individual 90 days to resolve the inconsistency with the Commissioner, or to present paper documentation of citizenship to the State.

•  Requires the Secretary of HHS to consult with the Commissioner and others to establish procedures related to appeals and periodic redeterminations of eligibility.

•  Authorizes the Secretary of HHS and the Exchanges to collect and use the Social Security number for purposes of carrying out this Act.

•  Restricts the use of the personal information submitted to an Exchange to ensuring the efficient operation of an Exchange, verifying eligibility to enroll in an Exchange, or claiming a premium tax credit or cost-sharing reduction. Also establishes penalties for disclosure of information collected by the Exchange.

•  Requires such citizenship verifications to begin with enrollment in the Exchange 1.

*National High-Risk Pool Program*

•  Requires the Secretary of HHS – or States or nonprofit private entities under contract with HHS – to verify the citizenship of individuals applying for health benefits under a new temporary national high-risk program, using the citizenship verification procedures previously described. Requires SSA to perform these citizenship verifications.

•  Effective beginning 90 days after enactment.

Income Verification

•  Requires individuals buying health insurance through an Exchange to provide income data in order to receive a premium tax credit. (SSA would not be involved in these determinations.) H.R. 4872 would require income eligibility determinations to be based on Modified Adjusted Gross Income (MAGI), rather than Modified Gross Income (MGI).

MEDICARE COVERAGE

Extension of Medicare Coverage for Environmental Health Hazards

•  Requires the Commissioner, in consultation with the Secretary of HHS, to determine whether individuals in geographic locations under declarations of public health emergencies have been affected by environmental health hazards, such as asbestos. The Commissioner is authorized to draw funds from the Health Insurance and Supplemental Medical Insurance Trust Funds to administer this workload.

•  Effective upon enactment.

MEDICARE PART B AND INCOME-RELATED MONTHLY ADJUSTMENTS

Temporary Freeze of the Part B Income-Related Premium

•  Freezes the current income thresholds for imposing income-related Medicare Part B premiums for the period of 2011 through 2019.

*TRICARE Special Enrollment Period*

•  Establishes a 12-month Medicare Part B special enrollment period (SEP) for TRICARE beneficiaries who are entitled to Medicare Part A by virtue of entitlement to disability insurance benefits or End Stage Renal Disease benefits, but who have declined Medicare Part B.

•  Defines the SEP as the 12 months following the last day of the initial enrollment period or, for individuals notified of retroactive Part A and Part B entitlement, the 12-month period beginning with the month of notification of entitlement to Part B.

•  Requires the Department of Defense, in collaboration with the Secretary of HHS and the Commissioner, to identify and notify individuals eligible to enroll during the SEP. Medicare Part B premium penalties would be waived.

•  Effective upon enactment.

*MEDICARE PART D AND INCOME-RELATED MONTHLY ADJUSTMENTS*

•  Imposes an income-related monthly adjustment amount (IRMAA) premium increase for Medicare Part D beneficiaries whose Modified Adjusted Gross Income (MAGI) exceeds the thresholds used under Medicare Part B (for 2009, $85,000 per individuals, $170,000 per couple).

•  Expands the Internal Revenue Service's current authority to disclose income information to SSA for purposes of adjusting the Part B subsidy to include the Part D subsidy adjustments and appeals.

•  Effective January 1, 2011.

*LOW-INCOME SUBSIDY*

Special Rules for Widows and Widowers

•  Prohibits conducting Part D Low Income Subsidy (LIS)-eligibility redeterminations on the surviving spouse of an LIS-eligible couple for one year after the date the next redetermination would have occurred after the death of the spouse.

•  Effective January 1, 2011.

MEDICAID

Medicaid Coverage for the Lowest Income Populations

•  Expands Medicaid eligibility to non-elderly individuals who are not entitled to or enrolled in Medicare Part A, or enrolled in Medicare Part B, and whose income, based on the Modified Gross Income (MGI) standard, does not exceed 133 percent of the Federal poverty level. H.R. 4872 would require income eligibility determinations to be based on MAGI, rather than MGI.

•  Effective January 1, 2014.

Incentives for Prevention of Chronic Diseases in Medicaid

•  Excludes incentives provided to Medicaid beneficiaries participating in the newly created prevention of chronic diseases programs from being counted when determining eligibility for, or the amount of, benefits under Medicaid or any program funded in whole or in part by Federal funds.

•  Effective January 1, 2011, or the date the Secretary of HHS develops criteria for the new program criteria, whichever is earlier.

WAGE REPORTING AND TAXES

W-2 Reporting Requirements

•  Requires employers to report on Forms W-2 the aggregate cost of sponsored health coverage.

•  Effective for taxable years beginning after December 31, 2010.

Additional W-2 Related Provisions

Hospital Insurance Tax on High-Income Taxpayers

•  Imposes an additional 0.9 percent tax for certain high-income wage earners and self-employed individuals. For joint filers, the additional tax applies to any wages above $250,000. For all others, the additional tax applies to any wages above $200,000. H.R. 4872 would add a “married filing separately” category, with the additional tax imposed on any wages above $125,000.

•  Effective for taxable years beginning after December 31, 2012.

Excise Tax on High-Cost Employer-Sponsored Health Coverage

•  Creates an excise tax on high-cost employer sponsored health coverage, including government civilian employment health insurance and health spending account programs.

•  Effective January 1, 2013. H.R. 4872 would change the effective date to January 1, 2018.

DATA SHARING

Complete “One PI” Integrated Data Repository

•  Requires the Integrated Data Repository, maintained by the Centers for Medicare and Medicaid Services, to include, at a minimum, claims and payment data from certain programs, including the Old-Age, Survivors, and Disability Insurance programs.

•  Requires the Secretary of HHS to enter into agreements with specified individuals, including the Commissioner, to share and match data in the respective agencies' systems of records for purposes of identifying potential fraud, waste, and abuse under Medicare and Medicaid.

•  Effective upon enactment.

Medicare and Medicaid Program Integrity

•  Requires the Commissioner, upon request of the Inspector General of HHS, to enter into agreements to match data in SSA's system of records to HHS's system of records. Such agreements must provide for the safeguarding of data.

•  Effective at a date specified by the Secretary of HHS, but no earlier than January 1, 2011.

MISCELLANEOUS

Interagency Working Group on Health Care Quality

•  Requires the President to convene an Interagency Working Group on Health Care Quality that would collaborate between Federal departments and agencies to develop strategies to improve health outcomes. The working group will be composed of senior-level officials from Federal departments and agencies, including SSA.

•  Requires the working group to provide annual reports to Congress—and make such reports public on an Internet website—the first of which would be due December 31, 2010.

Race/Ethnicity Data

•  Requires the Secretary of HHS to ensure that any federally conducted or supported health care or public health program, activity, or survey to include the collection of data related to race, ethnicity, sex, primary language, and disability status, among others.

•  Requires the Secretary to analyze and disseminate such information to other appropriate Federal agencies.

•  Effective for data collection not later than 2 years after the date of enactment.

Community Living Assistance Supports and Services (CLASS) Act

•  Excludes benefits paid under the CLASS program from being used to determine initial or continuing eligibility under any Federal, State, or locally funded assistance program.

•  Effective January 1, 2011.

NEW PROVISIONS IN H.R. 4872

Implementation Funding

•  Establishes a “Health Insurance Reform Implementation Fund” within HHS to carry out the “Patient Protection and Affordable Care Act” and amendments made by the “ Health Care and Education Reconciliation Act of 2010.”

•  Appropriates to the fund $1 billion for Federal administrative expenses to carry out the “Patient Protection and Affordable Care Act” and amendments made by such Act.

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1 As noted, enrollment in the Exchange begins January 1, 2014, but would likely be preceded by an initial enrollment period defined by the Secretary of HHS.