President Barack Obama signed “The Patient Protection and Affordable Care Act,” into law on Tuesday, March 23, 2010. This followed the March 21 passage by the U.S. House of Representatives of the U.S. Senate-passed health care reform bill (H.R. 3590). The following condensed summary details the timeline for implementation of the new health care reform law.

Within One Year

• Provides a $250 rebate to Medicare prescription drug plan beneficiaries whose initial benefits run out
• Provides a two-year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases. The credit would be available for qualifying investments made in 2009 and 2010

90 Days After Enactment

• Provides immediate access to high-risk pools for people who have no insurance because of preexisting conditions

Six Months After Enactment

• Bars insurers from denying people coverage when they get sick
• Bars insurers from denying coverage to children who have preexisting conditions
• Bars insurers from imposing lifetime caps on coverage
• Requires that all group health plans and plans in the individual market must provide first-dollar coverage for preventive services
• Requires that insurers allow children to stay on their parents’ policies until age 26
• Extends medical liability protections under the Federal Tort Claims Act to officers, governing board members, employees and contractors of free clinics
• Fully funded practice expense Geographic Practice Cost Index (GPCI) floor increase: 2010 and 2011
• Establish the Patient-Centered Outcomes Research Institute to contract with appropriate federal agencies or the private sector to conduct comparative effectiveness research (CER)

2011

• Requires individual and small group market insurance plans to spend 80 percent of premium dollars on medical services. Large group plans would have to spend at least 85%
• Effective January 1, 2011 through December 31, 2015, primary care physicians (family medicine, internal medicine, geriatric medicine or pediatric medicine) and practitioners (NP, CNS, or PA) for whom primary care services (HCPCS codes 99201- 99215; 99304-99340; and 99341-99350) account for at least 60 percent of Medicare allowed charges over a designated time period will receive a 10 percent bonus payment
• Requires funding for state demonstration programs to evaluate alternative liability reform models authorized for five fiscal years
• Effective for 2011 through 2014, the Physician Quality Reporting Initiative (PQRI) bonus will be 1 percent in 2011 and 0.5 percent bonus in subsequent years
• Requires the Secretary of Health and Human Services (HHS) to convene stakeholders meeting to receive input on an ICD-9-CM to ICD-10 crosswalk by January 1, 2011
• Establish coverage for Medicare wellness and preventive care services through the elimination of coinsurance
• Establish coverage for preventive services and eliminate cost-sharing for such services in Medicaid
• Establish new restrictions on physician ownership of specialty hospitals. The new requirement will be effective 18 months after enactment. To qualify for exception, the physician ownership or investment and provider agreement must be in place by August 1, 2010 (or December 31, 2010 if the Reconciliation Bill is enacted)

2012

• Encourage physicians to join together to form “accountable care organizations” to gain efficiencies and improve quality
• Establishes a hospital value-based purchasing program for acute care hospitals
• Directs CMS to track hospital readmission rates for certain high-cost conditions and implements a payment penalty for hospitals with the highest readmission rates

2013

• Increases the Medicare payroll tax and expands it to dividend, interest and other unearned income for singles earning more than $200,000 and joint filers making more than $250,000
• Alters the Medicare physician payment (SGR) to include a new value-based payment modifier
• Establishes a national pilot program on payment bundling for hospitals, doctors, and post-acute care providers
• Effective January 1, 2013, physician performance information will be made public through a physician compare website

2014

• Provides subsidies for families earning up to 400 percent of the poverty level — or, under current guidelines, about $88,000 a year — to purchase health insurance
• Requires most employers to provide coverage or face penalties
• Requires most people to obtain coverage or face penalties
• Institutes additional insurance market reforms, including limitations on pre-existing health conditions, and rating rules (only vary on age, geography, and family size)
• Medicaid eligibility will increase to 133 percent of poverty for all non-elderly individuals
• Continues the second phase of the small business tax credit for qualified small employers
• Requires certain providers — including long-term care hospitals, inpatient rehabilitation facilities, PPS-exempt cancer hospitals and hospice providers — to implement quality measure reporting programs

2015

• Establishes the Independent Payment Advisory Board (IPAB)
• Effective 2015, the PQQRI becomes mandatory. Physicians who don't report in the program will face 1.5 percent penalties in 2015 and 2 percent in subsequent years
• Effective January 1, 2015, the value-based purchasing index (also called cost/quality value index) is phased in for some physicians. Payment adjustment will be made based on 2014 performance. All physicians will be subject to this index starting January 1, 2017

2018

• Imposes a 40 percent excise tax on high-end insurance policies

2019

• Expands health insurance coverage to 32 million people