Cost Containment

Simplify health insurance administration with timely claims and denial of management processes and use of standard electronic transactions.

Limit annual increases in Exchange plans by no more than 150% of the annual percentage increase in medical inflation.

Medicare modifications:
*Reduce payments for preventable hospital readmissions.
*Modify market updates to account for productivity for inpatient facilities.
*Medicare Advantage plans would be 100% free-for-service payments, with bonuses for quality.

Medicaid modifications:
*Increase drug rebate percentage and extend prescription drug rebate to managed plans.
*Require drug manufacturers to provide drug rebates for dual eligibles enrolled in Part D plans.
*Negotiate lower drug prices for part D plans and Advantage Part D plans.
*Reduces DSH payments by $6 billion in 2019.
*Refuse payments to certain nosocomial infections.

Hospitals must report nosocomial infections to centers for Disease Control and Prevention.

Allow FDA to approve generic versions of biologic drugs and grant biologic manufacturers 12 years of exclusive use before generics can be developed.

Allow provider screenings, enhanced oversight periods, and enrollment moratoria in areas that are at risk for fraud in all public programs.

Medicaid and Medicare program providers and suppliers will be required to establish compliance programs.

Remington Stickney

Information cited from:
Kaiser Family Foundation (October 15, 2009). Health Care Reform Proposals. Retrieved from http://www.kff.org/healthreform/upload/healthreform_tri_full.pdf.