January 2011 Implementation Update: 7 Major Changes Ahead

by Rebecca Farley on January 4, 2011

Health reform implementation continues with a host of changes that went into effect on January 1, 2011. Here are 7 of the major changes with an impact on the behavioral health field:

  • Medicaid Health Homes State Option: States may now amend their Medicaid programs to provide chronic disease management to targeted Medicaid beneficiaries through health homes. State Plan Amendments must include information about how the behavioral health needs of health homes beneficiaries will be addressed. Click for more information.
  • Closing the Donut Hole: CMS continues working to close the Medicare coverage gap (or “donut hole”) by requiring pharmaceutical companies to provide a 50% discount on brand-name drugs for beneficiaries in 2011 who reach the donut hole. With additional changes to come in 2012 and future years, the donut hole will be phased out entirely by 2020. Click for more.

  • Center for Medicare and Medicaid Innovation: The new Center is tasked with examining ways of delivering health services and new systems of provider payment that can save money while improving the quality of care. Click for more.
  • Free Medicare Preventive Benefits: Beginning January 1, certain preventive benefits in Medicare will now be available without a co-pay. These preventive benefits include annual wellness visits. Click for more.
  • Community Living Assistance Services and Supports (CLASS): CLASS is a voluntary, long-term care insurance program for the purchase of home- and community-based services by individuals with functional impairments. Premiums are paid through voluntary payroll deductions. Employers may begin offering payroll deductions as of Jan. 1; there is a 5-year waiting period for benefits to take effect. Click for more.
  • Primary Care Payment Increase: A 10% increase in Medicare payments for primary care went into effect Jan. 1. Click for more.
  • Minimum Medical Loss Ratio: Health reform requires insurance companies to spend at least 80-85% of consumers’ premiums on paying for actual patient care, rather than administrative costs or profit. Click for more.

Visit the Implementation Tracker section of our blog for information about the health reform provisions that went into effect in previous months. Or, click here to see a full timeline of all changes going into effect this year.

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{ 4 comments… read them below or add one }

Larry Miskimins January 4, 2011 at 2:13 pm

Is ther mandatory long term care insurance included in Obamcare? and if so can you opt out of it if you already have LTC ins?


Rebecca Farley January 11, 2011 at 8:22 am

Participation in the CLASS long-term care insurance program is optional. Additional details about this program can be found by clicking the link in the post above. There is no mandatory LTC insurance program in health reform.

- Rebecca Farley, Policy Associate, National Council for Community Behavioral Healthcare


Helen Fowler January 7, 2011 at 2:34 pm

These changes are mostly regarding Medicare and Medicaid. Are there any changes for people with private health insurance?


Rebecca Farley January 11, 2011 at 7:56 am

Most of the changes that went into effect on Jan. 1, 2011 deal with Medicare and Medicaid. Several significant changes relating to private insurance became effective in Sept. 2010 – you can read about them on this blog in our Sept. implementation update (http://mentalhealthcarereform.org/sept-23-coverage-milestones-your-questions-answered/).

For more information about the private insurance provisions of health reform, see our Summary Chart of the Health Reform Law (http://www.thenationalcouncil.org/galleries/policy-file/HCR%20Summary%20Chart%20Updated%20with%20Approps%20Info%2010-22-10.pdf).

- Rebecca Farley, Policy Associate, National Council for Community Behavioral Healthcare


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