What health reform changes to expect in 2012 — assuming the Supreme Court doesn't strike down the entire law

The U.S. Supreme Court is set to hear arguments later this month about the federal health care-reform law, and is expected to decide the law's future this summer. While the court mulls the constitutionality of an individual mandate to buy health insurance, "implementation marches on, and a number of notable changes will take effect for consumers this year," writes Michelle Andrews for Kaiser Health News.

If the high court strikes down the Patient Protection and Affordable Care Act, "all bets are off," Andrews writes. Popular provisions, such as allowing children to stay on their parents' insurance until age 26 and the 50 percent discount on brand-name drugs for seniors under the prescription drug doughnut hole, could be eliminated — and provisions set to take effect this year could be cancelled. But, if the Supreme Court does not invalidate the entire law, here's a list of new provisions consumers can expect this year:

Free contraception coverage: "Women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge," Andrews writes. Insurance plans will also have to provide basic health services for women, including screening for gestational diabetes; HPV testing; STD counseling; screening and testing for HIV; and screening and counseling for interpersonal and domestic violence. Religious employers such as churches are exempt from the new regulation, but colleges, hospitals and other employers that are religiously affiliated are not — though they do have a one-year grace period to implement it. Employees of those institutions will receive their free benefit from their employer's insurance.

Consumer rebates: Under the law, insurance companies have to spend at least 80 to 85 of their premium revenues on medical claims and quality improvement. If they don't, they have to pay the difference to policyholders, which, in most plans, means the employer. If the provision had been in place in 2010, an analysis by the National Association of Insurance Commissioners estimated that would have meant $2 billion going to consumers. In December, the Obama administration said that about 9 million Americans could receive rebates that added up to $1.4 billion.

Clearer descriptions: Starting in September, all health plans will have to give consumers benefits information that is easy to understand. "Every plan will be required to give people a short summary of coverage and a uniform glossary of terms," Andrews reports. "It will also have to provide examples of how much the plan would cover if someone had a baby or was managing Type 2 diabetes — two common situations that should make it easier for people to compare plans."

Smaller doughnut hole: "This is the break in Medicare prescription drug benefits that, in a standard plan, begins after total drug spending by the beneficiary and the health plan exceeds $2,930 and continues until the beneficiary has hit the $4,700 out-of-pocket limit," Andrews reports. Last year, people on Medicare with high drug costs got a 50 percent discount on brand-name drugs once they reached the doughnut hole. This year, they'll also get a 14 percent discount on generic drugs. (Read more)

Several pieces of federal health reform law taking effect in 2012

At the beginning of the new year, family doctors started facing a 1 percent cut in Medicare reimbursement if they hadn't nixed their paper-based prescription pads in favor of an electronic version. The change is part of another piece of the federal health-care reform law taking effect, USA Today reports.

"There will be a significant number of folks that will incur the penalty," said Robert Tennant, senior policy adviser with the Medical Group Management Association.

E-prescribing, which allows physicians to generate, transmit and file patient prescriptions, is part of the federal government's effort to get doctors to use electronic health records. Last year, doctors received bonuses from Medicare and Medicaid to set up EHRs, but this year they will start being penalized if they haven't already done so — 1 percent this year, 1.5 percent in 2013 and 2 percent in 2014.

Another piece of the federal health care reform law that will begin falling into place in 2012 involves Medicare's Shared Savings Program, "under which groups that qualify as accountable care organizations will be eligible for shared savings in 2013," USA Today reports. "Under the program, savings from participants in an ACO — including hospitals and doctors working together to improve patient care and reduce costs — would be shared between Medicare and the providers."

One study showed Kentucky already has three ACOs established, though several Kentucky experts have said no ACOs have been formed in the state yet.

Jan. 1 also marked the beginning of consumers being eligible for rebates if their insurer spent less than it should have on medical care. As per the new law, insurers have to spend 85 percent for large group plans and 80 percent for small groups and individuals on medical care as opposed to administrative and other costs. Kentuckians will not be privy to these rebates this year, however. Kentucky got a one-year break from the rule after applying for an exemption. (Read more)

Kentucky has three accountable care organizations, a health-reform linchpin, but they remain to be identified

The "accountable care organization" is one of the hallmarks of the federal health-care reform law, with doctors and providers encouraged to team up to give coordinated care and be paid financial incentives to do so.

While being heavily promoted, they were recently likened to "unicorns" because "no one has ever seen one." That's what William Hazel, Virginia secretary for health and human services, at the Howard L. Bost Memorial Health Policy Forum in Somerset in September.

But now a new study has emerged indicating ACOs are popping up all over the country and that there are three in Kentucky, two part of a hospital system and the other part of an independent physician association. A spokesman at Leavitt Partners, which conducted the study, would not disclose the names of the Kentucky ACOs.

To get their count, "Leavitt Partners examined news releases, media reports, trade groups and conducted interviews and considered a health system to be an ACO if it either self-identified as one or was 'adopting the tenets of accountable care,'" reports Jenny Gold with Kaiser Health News.

Of the 164 ACO entities identified nationwide, 99 were sponsored by hospital systems, 38 by physician groups and 27 by insurers. Nationwide, 41 states had ACOs, "though there were vast regional differences. Poor and rural regions were found to have little ACO growth," Gold reports. In the Southeast and Appalachian regions of the country, there are few ACOs forming.

The findings run counter to what was discussed at a recent meeting of the Friedell Committee, whose members said there are no existing ACOs in Kentucky, though they did acknowledge ACOs would have a hard time developing in rural areas: "If you know anything at all about ACOs, you know they're driving by volume," said Cris Miller, a partner in the Louisville accounting firm of Mountjoy Chilton Medley. "We're going to have a few in Louisville, probably as many as three in Lexington. Maybe have one in Bowling Green, one in Paducah. But I can promise you we will not have one in Pikeville, we will not have one in Somerset. There's not enough population."

The discrepancy might have to do with the definition of ACO. The report notes that while the term ACO has been recently adopted, its tenets are not new and organizations have been using the health care delivery model for years, just not calling it accountable care. "The study authors determined that their findings suggested a trend toward 'proclaiming oneself as an ACO with only modest changes to the care process' and not a total redesign," Gold reports. (Read more)

Funds available for critical-access hospitals, rural health-care providers through new federal program

Critical-access hospitals, physician-owned organizations and rural health-care providers are now eligible for federal funds that will help them implement necessary infrastructure and information-technology systems, the U.S. Department of Health and Human Services announced last week. The goal of the program, called the Advanced Payment Model, is to encourage participation in accountable care, one of the cornerstones of the health-care reform law.

Eligible participants must be either accountable care organizations "that do not include any inpatients facilities and have less than $50 million in total annual revenue," or ACOs in which inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals and have less than $80 million in annual revenue, reports Karen Cheung in Fierce Healthcare.

An accountable care organization is a network of physicians and hospitals that share the responsibility to care for a group of patients. The organization's payment is tied to achieving health-care quality goals and outcomes. While ACOs are being heavily promoted in the new health care system, they were recently likened to "unicorns" because "no one has ever seen one," said William Hazel, Virginia secretary for Health and Human Resources, at the 2011 Howard L. Bost Memorial Health Policy Forum in Somerset. (Read more)