Friday, July 13, 2012

The Truth About Obamacare, Part IV: Queen Kathleen

Kathleen Sebelius is now the Queen of HHS, not the Secretary.  Just read this brief excerpt from part 2 of the PPACA.


PART 2—CONSUMER CHOICES AND INSUR- 
ANCE COMPETITION THROUGH HEALTH 
BENEFIT EXCHANGES 
SEC. 1311 ø42 U.S.C. 13031¿. AFFORDABLE CHOICES OF HEALTH BEN- 
EFIT PLANS. 
(a) ASSISTANCETOSTATES TOESTABLISHAMERICANHEALTH 
BENEFITEXCHANGES.— 
(1) PLANNINGANDESTABLISHMENT GRANTS.—There shall 
be appropriated to the Secretary, out of any moneys in the 
Treasury not otherwise appropriated, an amount necessary to 
enable the Secretary to make awards, not later than 1 year 
after the date of enactment of this Act, to States in the amount 
specified in paragraph (2) for the uses described in paragraph 
(3). 
(2) AMOUNTSPECIFIED.—For each fiscal year, the Secretary 
shall determine the total amount that the Secretary will make 
available to each State for grants under this subsection. 
(3) USEOFFUNDS.—A State shall use amounts awarded 
under this subsection for activities (including planning activi- 
ties) related to establishing an American Health Benefit Ex- 
change, as described in subsection (b). 
(4) RENEWABILITYOFGRANT.— 
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June 9, 2010 
70 
Sec. 1311 PPACA (Consolidated) 
(A) INGENERAL.—Subject to subsection (d)(4), the Sec- 
retary may renew a grant awarded under paragraph (1) if 
the State recipient of such grant— 
(i) is making progress, as determined by the Sec- 
retary, toward— 
(I) establishing an Exchange; and 
(II) implementing the reforms described in 
subtitles A and C (and the amendments made by 
such subtitles); and 
(ii) is meeting such other benchmarks as the Sec- 
retary may establish. 
(B) LIMITATION.—No grant shall be awarded under 
this subsection after January 1, 2015. 
(5) TECHNICALASSISTANCETOFACILITATEPARTICIPATIONIN 
SHOP EXCHANGES.—The Secretary shall provide technical as- 
sistance to States to facilitate the participation of qualified 
small businesses in such States in SHOP Exchanges. 
(b) AMERICANHEALTHBENEFITEXCHANGES.— 
(1) INGENERAL.—Each State shall, not later than January 
1, 2014, establish an American Health Benefit Exchange (re- 
ferred to in this title as an ‘‘Exchange’’) for the State that— 
(A) facilitates the purchase of qualified health plans; 
(B) provides for the establishment of a Small Business 
Health Options Program (in this title referred to as a 
‘‘SHOP Exchange’’) that is designed to assist qualified em- 
ployers in the State who are small employers in facili- 
tating the enrollment of their employees in qualified 
health plans offered in the small group market in the 
State; and 
(C) meets the requirements of subsection (d). 
(2) MERGEROFINDIVIDUALANDSHOPEXCHANGES.—A State 
may elect to provide only one Exchange in the State for pro- 
viding both Exchange and SHOP Exchange services to both 
qualified individuals and qualified small employers, but only if 
the Exchange has adequate resources to assist such individuals 
and employers. 
(c) RESPONSIBILITIESOFTHESECRETARY.— 
(1) INGENERAL.—The Secretary shall, by regulation, estab- 
lish criteria for the certification of health plans as qualified 
health plans. Such criteria shall require that, to be certified, 
a plan shall, at a minimum— 
(A) meet marketing requirements, and not employ 
marketing practices or benefit designs that have the effect 
of discouraging the enrollment in such plan by individuals 
with significant health needs; 
(B) ensure a sufficient choice of providers (in a manner 
consistent with applicable network adequacy provisions 
under section 2702(c) of the Public Health Service Act), 
and provide information to enrollees and prospective en- 
rollees on the availability of in-network and out-of-network 
providers; 
(C) include within health insurance plan networks 
those essential community providers, where available, that 
serve predominately low-income, medically-underserved in- 
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June 9, 2010 
71 Sec. 1311 
PPACA (Consolidated) 
dividuals, such as health care providers defined in section 
340B(a)(4) of the Public Health Service Act and providers 
described in section 1927(c)(1)(D)(i)(IV) of the Social Secu- 
rity Act as set forth by section 221 of Public Law 111–8, 
except that nothing in this subparagraph shall be con- 
strued to require any health plan to provide coverage for 
any specific medical procedure; 
(D)(i) be accredited with respect to local performance 
on clinical quality measures such as the Healthcare Effec- 
tiveness Data and Information Set, patient experience rat- 
ings on a standardized Consumer Assessment of 
Healthcare Providers and Systems survey, as well as con- 
sumer access, utilization management, quality assurance, 
provider credentialing, complaints and appeals, network 
adequacy and access, and patient information programs by 
any entity recognized by the Secretary for the accredita- 
tion of health insurance issuers or plans (so long as any 
such entity has transparent and rigorous methodological 
and scoring criteria); or 
(ii) receive such accreditation within a period estab- 
lished by an Exchange for such accreditation that is appli- 
cable to all qualified health plans; 
(E) implement a quality improvement strategy de- 
scribed in subsection (g)(1); 
(F) utilize a uniform enrollment form that qualified in- 
dividuals and qualified employers may use (either elec- 
tronically or on paper) in enrolling in qualified health 
plans offered through such Exchange, and that takes into 
account criteria that the National Association of Insurance 
Commissioners develops and submits to the Secretary; 
(G) utilize the standard format established for pre- 
senting health benefits plan options; 
(H) provide information to enrollees and prospective 
enrollees, and to each Exchange in which the plan is of- 
fered, on any quality measures for health plan perform- 
ance endorsed under section 399JJ of the Public Health 
Service Act, as applicable; and 
(I) report to the Secretary at least annually and in 
such manner as the Secretary shall require, pediatric qual- 
ity reporting measures consistent with the pediatric qual- 
ity reporting measures established under section 1139A of 
the Social Security Act. øAs added by section 10203(a)¿ 
(2) RULEOFCONSTRUCTION.—Nothing in paragraph (1)(C) 
shall be construed to require a qualified health plan to contract 
with a provider described in such paragraph if such provider 
refuses to accept the generally applicable payment rates of 
such plan. 
(3) RATINGSYSTEM.—The Secretary shall develop a rating 
system that would rate qualified health plans offered through 
an Exchange in each benefits level on the basis of the relative 
quality and price. The Exchange shall include the quality rat- 
ing in the information provided to individuals and employers 
through the Internet portal established under paragraph (4). 

1 comment:

Anonymous said...

UN PRESIDENT TIM KALEMKARIAN, US PRESIDENT TIM KALEMKARIAN, US SENATE TIM KALEMKARIAN, US HOUSE TIM KALEMKARIAN: BEST MAJOR CANDIDATE.