Jan. 1, 2013
• CMS starts five-year bundled payment pilot program for Medicare, covering 10 conditions.
• CMS increases Medicaid payments for primary care services to 100% of Medicare’s rate (funded for two years).
• IRS increases Medicare tax rate to 2.35% on individuals earning more than $200,000 and on married couples earning more than $250,000; also imposes 3.8% tax on unearned income among high-income taxpayers.
• IRS begins assessing excise tax of 2.3% on sale of taxable medical devices.
Jan. 2, 2013
• Sequestration results in across-the-board cuts of 2% in Medicare reimbursements.
July 1, 2013
• DHS officially launches Consumer Operated and Oriented Plan (CO-OP) to encourage growth of nonprofit health insurers (roughly $2 billion in loans given to co-ops in 23 states by end of 2012).
Oct. 1, 2013
• Open enrollment begins for state- and federal government-run health insurance exchanges and expanded Medicaid; the rollout is marred by multiple computer glitches.
• CMS lowers Medicare Disproportionate Share Hospital (DSH) payments by 75%, starting in FY2014 but plans to supplement these payments based on each hospital’s share of uncompensated care.
• CMS lowers Medicaid DSH payments by $22 billion over 10 years, beginning with $500 million reduction in FY2014.
Jan. 1, 2014
• Coverage begins through health insurance exchanges. Individuals and families with incomes between 100% and 400% of the federal poverty level can receive subsidies to help pay for premiums.
• Voluntary Medicaid expansions expected to take place in roughly half of all states, for individuals up to 138% of the federal poverty level.
• Insurers banned from imposing annual limits on coverage, from restricting coverage due to pre-existing conditions, and from basing premiums on gender.
• Insurers required to cover 10 “essential health benefits,” including medication and maternity care.
March 31, 2014
• Open enrollment closes for health insurance exchanges; under the “individual mandate,” people who qualify but don’t buy insurance by this date will be penalized up to 1% of income (penalty increases in subsequent years).
Oct. 1, 2014
• CMS imposes 1% reduction in payments to hospitals with excess hospital-acquired conditions (FY2015).
• CMS imposes penalties on hospitals that haven’t met electronic health record (EHR) meaningful use requirements.
Jan. 1, 2015
• Employer Shared Responsibility Payment, or the “employer mandate,” begins (delayed from Jan. 1, 2014). With a few exceptions, employers with more than 50 employees must offer coverage or pay a fine.
• CMS begins imposing fines based on doctors who didn’t meet Physician Quality Reporting System requirements during 2013, with an initial 1.5% penalty that rises to 2% in 2016.
Jan. 1, 2018
• High-cost, or so-called “Cadillac,” insurance plans—those with premiums over $10,200 for individuals or $27,500 for family coverage—will be assessed an excise tax.