Day 4 -

Sec. 2717
Ensuring the Quality of Care.

Quality Reporting:

1) the Secretary (of Health and Human Services - currently Sec. Sebelius- along with experts
will develop reporting requirements to
A) improve health outcomes by implementing
quality reporting,
effective case management,
care coordination,
chronic disease management (don't we already do this? )
and medication and care compliance initiatives. (somebody tell me what these are!)

B) implement activities to prevent hospital readmissions through
a comprehensive program for hospital discharge that includes
patient-centered education and counseling,
comprehensive discharge planning and
post discharge reinforcement by an appropriate health care professional... (huh? somebody goes home with us?)

C) implement activities to improve patient safety and reduce medical errors through
the appropriate use of best clinical practices,
evidence based medicine
and health information technology (do you want your medical records on government computers?)

D) implement wellness and health promotion activities.... well duh! Sorry, that is bias, but this is so simplistic and condescending... don't they think these ideas are already implemented?

2) Reporting Requirements:
A) In General: the health insurance issuers (companies) will annually submit to the Secretary and to the enrollees

a report on whether the benefits under their plan satisfy the elements of the above A through D paragraphs.

B) Timing: an enrollee can get a report during each enrollment period.
C) Availability: reports will be on the internet
D) Penalties: the Secretary may impose appropriate penalties for non-compliance
E) Exceptions: the Secretary may provide for exceptions to these requirements.

Wellness and Prevention Programs:
regarding D above:
may be:
smoking cessation
weight management
stress management
physical fitness
nutrition
heart disease prevention
healthy lifestyle support
diabetes prevention

using services of a health care provider
a wellness and prevention plan manager
a health, wellness or prevention organization

that conducts health risk assessments
offers ongoing
face to face
telephonic
or web-based intervention efforts

Study and Report: the Government Accountability Office will
report on the impact of the activities in this section 2717 have
had an impact on the quality and cost of health care.

Section 2718
Bringing down the cost of health care coverage (now we are getting down to it....)

a) clear accounting for Costs -
A health insurance issuer (company) will report to the Secretary the percentage of
total premium revenue that they spend
on reimbursement for clinical services
for activities that improve health care quality
and all other non-claim costs, including an explanation of the nature of such costs
These reports will be available on the internet

(Dianne's comments: is anyone else noticing the number of reports being required?
who is generating them, who is receiving them, and who is doing something with them?)


b) Ensuring that consumers receive value for their premium payments:
1) a health insurance issuer will give a rebate to consumers
if they have to expend money for the non-claim costs mentioned above
before Dec. 2013.

c) Standard Hospital Charges:
Each year each hospital will establish a make public a list of their charges for items and
services.

Section 2719
Appeals Process
A health insurance issuer shall provide an appeals process....

Section 1002
amends former law by adding:
Section 2793:
a) in general - the Secretary shall award grants (Dianne's comment: where does the money come from for the grants?)
to the States to enable them to establish, expand or provide support for
1) offices of health insurance consumer assistance or
2) health insurance ombudsman (advocate) programs
b) eligibility
c) duties (the usual advocate duties)
d) data collection and report to Secretary-the Secretary shall utilize such data to identify
areas where more enforcement action is necessary.... (Dianne's comments: "enforcement action"? what is that?)
e) Funding $30,000,000.00 for the first year for just this section... and for such sums as may be necessary to carry out this section (Dianne's comments: Yikes!)

Well, we have finished sections 1001 and 1002.... yeah! only a kazillion to go!

see you tomorrow