HCR Timeline

  • January 1 2018 Tax on High-Cost Insurance
    Imposes an excise tax on insurers of employer-sponsored health plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.

    Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager

  • January 1 2016Health Care Choice Compacts
    Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact.

    Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager

  • Jan. 1 2015 Employer Requirements
    Assesses a fee of $2,000 per full-time employee, excluding the first 30 employees, on employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with more than 50 employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees.
  • October 1 2015Increase Federal Match for CHIP
    Provides for a 23 percentage point increase in the Children’s Health Insurance Program (CHIP) match rate up to a cap of 100%.

    Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager

  • Fiscal Year 2015 Medicare Payments for Hospital-Acquired Infections
    Reduces Medicare payments to certain hospitals for hospital-acquired conditions by 1%.

    For more information on HCR Compliance Deadlines and alerts subscribe to Health Care Reform Milestone Manager

  • January 1 2014 Expanded Medicaid Coverage
    Expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 138% FPL and provides enhanced federal matching payments for new eligibles.

    states have the option to expand coverage to childless adults beginning April 1, 2010

    Health Care Reform Milestone Manager

  • January 1 2014 Presumptive Eligibility for Medicaid
    Allows all hospitals participating in Medicaid to make presumptive eligibility determinations for all Medicaid-eligible populations.

    Proposed Rule: On January 22, 2013, CMS issued a proposed rule addressing issues related to the Medicaid expansion, including presumptive eligibility. The final rule laying out the requirements for presumptive eligibility by hospitals was issued on July 15, 2013.

    To get more HCR News check out HCR Central

  • January 1 2014 Individual Requirement to Have Insurance
    Requires U.S. citizens and legal residents to have qualifying health coverage (there is a phased-in tax penalty for those without coverage, with certain exemptions). Update: On July 1, 2013, HHS issued a final rule that establishes the standards and processes for the Exchanges to determine eligibility for and grant exemptions from the individual shared responsibility payment.

    To get more HCR News check out HCR Central

  • January 1 2014 Health Insurance Exchanges
    Creates state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through the Exchanges and Medicaid and CHIP programs.
  • January 1 2014 Health Insurance Premium and Cost Sharing Subsidies
    Provides refundable and advanceable tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the Exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.

    Update:On May 23, 2012, the IRS released final regulations related to the health insurance premium tax credits. Corrections to this regulation were published on July 17, 2012. Additionally, on January 30, 2013, IRS released a final rule on the premium tax credit test for affordability of employer-sponsored insurance.

  • January 1 2014 Guaranteed Availability of Insurance
    Requires guarantee issue and renewability of health insurance regardless of health status and allows rating variation based only on age (limited to a 3 to 1 ratio), geographic area, family composition, and tobacco use (limited to 1.5. to 1 ratio) in the individual and the small group market and the Exchanges.

    On February 28, 2013, HHS issued a final rule implementing guaranteed availability of insurance.

  • January 1 2014 No Annual Limits on Coverage
    Prohibits annual limits on the dollar value of coverage.

    Update:On June 28. 2010, HHS issued interim final regulations prohibiting lifetime and annual limits on coverage.

  • January 1 2014 Essential Health Benefits
    Creates an essential health benefits package that provides a comprehensive set of services, limiting annual cost-sharing to the Health Savings Account limits ($5,950/individual and $11,900/family in 2010). Creates four categories of plans to be offered through the Exchanges, and in the individual and small group markets, varying based on the proportion of plan benefits they cover.

  • January 1 2014 Multi-State Health Plans
    Requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

    For more information on HCR Compliance Deadlines and alerts subscribe to Health Care Reform Milestone Manager

  • 2014 Temporary Reinsurance Program for Health Plans Begins
    Creates a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals.

    Implementation: January 1, 2014 through December 31, 2016

  • January 1 2014 Basic Health Plan
    Permits states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.
  • January 1 2014 Medicare Advantage Plan Loss Ratios
    Requires Medicare Advantage plans to have medical loss ratios no lower than 85%.

    For more information on HCR Compliance Deadlines and alerts subscribe to Health Care Reform Milestone Manager

  • January 1 2014 Wellness Programs in Insurance
    Permits employers to offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in a wellness program and meeting certain health-related standards; establishes 10-state pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

    Implementation:Changes to employer wellness plans effective January 1, 2014; 10-state pilot programs established by July 1, 2014

  • January 1 2014 Fees on Health Insurance Sector
    Imposes new fees on the health insurance sector.
  • October 1 2013 Medicaid Disproportionate Share Hospital Payments
    Reduces states’ Medicaid Disproportionate Share Hospital (DSH) allotments and requires the Secretary to develop a methodology for distributing the DSH reductions.
  • October 1 2013 Medicare Disproportionate Share Hospital Payments
    Reduces Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increases payments based on the percent of the population uninsured and the amount of uncompensated care provided.
  • July 1 2013 CO-OP Health Insurance Plans
    Creates the Consumer Operated and Oriented Plan (CO-OP) to foster the creation of non-profit, member-run health insurance companies.

    Implementation: CO-OPs established by July 1, 2013

  • March 31 2014Financial Disclosure Due
    Requires disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.
  • January 1 2013 Tax on Medical Devices
    Imposes an excise tax of 2.3% on the sale of any taxable medical device.
  • January 1 2013Employer Retiree Coverage Subsidy
    Eliminates the tax-deduction for employers who receive Medicare Part D retiree drug subsidy payments.
  • January 1 2013 Medicare Tax Increase
    Increases the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and imposes a 3.8% assessment on unearned income for higher-income taxpayers.
  • January 1 2013 Flexible Spending Account Limits
    Limits the amount of contributions to a flexible spending account for medical expenses to $2,500 per year, increased annually by the cost of living adjustment.
  • January 1 2013 Itemized Deductions for Medical Expenses
    Increases the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.
  • January 1 2013 Medicaid Payments for Primary Care
    Increases Medicaid payments for primary care services provided by primary care doctors to 100% of the Medicare payment rate for 2013 and 2014 (financed with 100% federal funding).

    Implementation:January 1, 2013 through December 31. 2014

  • January 1 2013 Medicaid Coverage of Preventive Services
    Provides a one percentage point increase in federal matching payments for preventive services in Medicaid for states that offer Medicaid coverage with no patient cost sharing for services recommended (rated Br B) by the U.S. Preventive Services Task Force and recommended immunizations.
  • January 1 2013Medicare Bundled Payment Pilot Program
    Establishes a national Medicare pilot program to develop and evaluate making bundled payments for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.
  • January 1 2013 State Notification Regarding Exchanges
    States indicate to the Secretary of HHS whether they will operate an American Health Benefit Exchange.

    Learn more: Where are states in establishing and implementing their health insurance exchanges? Check out HCR Central for the latest news on the ACA and exchanges.

  • Fiscal year 2013Extension of CHIP
    Extends authorization and funding for the Children’s Health Insurance Program (CHIP) through 2015 (current authorization is through 2013).
  • October 1 2012 Reduced Medicare Payments for Hospital Readmissions
    Reduces Medicare payments that would otherwise be made to hospitals to account for excess (preventable) hospital readmissions.
  • October 1 2012 Medicare Value-Based Purchasing
    Establishes a hospital value-based purchasing program in Medicare to pay hospitals based on performance on quality measures and requires plans to be developed to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.
  • August 31, 2012 Changes in Medicare Provider Rates
    Reduces annual market basket updates for inpatient and outpatient hospital services, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals and units and adjusts payments for productivity. Implementation: Beginning fiscal year 2010; productivity adjustments added to market basket update in 2012
  • March 23 2012 Data Collection to Reduce Health Care Disparities
    Requires enhanced collection and reporting of data on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations.
  • January 1 2012Medicaid Payment Demonstration Projects
    Creates new demonstration projects in Medicaid for up to eight states to pay bundled payments for episodes of care that include hospitalizations and to allow pediatric medical providers organized as accountable care organizations to share in cost-savings.

    Implementation: January 1, 2012 through December 31, 2016

  • January 1 2012Annual Fees on the Pharmaceutical Industry
    Imposes new annual fees on the pharmaceutical manufacturing sector.
  • January 1 2012Fraud and Abuse Prevention
    Establishes procedures for screening, oversight, and reporting for providers and suppliers that participate in Medicare, Medicaid, and CHIP; requires additional entities to register under Medicare.
  • January 1 2012Medicare Advantage Plan Payments
    Reduces rebates paid to Medicare Advantage plans and provides bonus payments to high–quality plans.
  • January 1 2012Accountable Care Organizations in MedicareJanuary 1 2012
    Allows providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.
  • October 1 2011 Medicaid Long-Term Care Services
    Creates the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services and establishes the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities.
  • October 1 2011 Medicare Independent Payment Advisory Board
    Authorizes an Independent Advisory Board, comprised of 15 members nominated by the President and Congress, subject to Senate confirmation, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds targeted growth rates.

    Implementation: Funding available October 1, 2011; beginning in 2013, CMS Chief Actuary issues determination of whether Medicare spending exceeds target growth rates; first recommendations would be due January 15, 2014 to take effect in 2015 if the Medicare spending growth rate exceeds the target growth rate.

  • January 1 2012Medicare Independence at Home Demonstration
    Creates the Independence at Home demonstration program to provide high-need Medicare beneficiaries with primary care services in their home.
  • July 1 2011Graduate Medical Education
    Increases the number of Graduate Medical Education (GME) training positions by redistributing currently unused slots and promotes training in outpatient settings.
  • July 1 2011Medicaid Payments for Hospital-Acquired Infections
    Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections.
  • March 23, 2011Funding for Health Insurance Exchanges
    Provides grants to states to begin planning for the establishment of American Health Benefit Exchanges and Small Business Health Options Program Exchanges, which facilitate the purchase of insurance by individuals and small employers.

    Implementation: Grants awarded starting March 23, 2011; applications will be accepted through October 15, 2014

  • January 1 2011 Changes to Tax-Free Savings Accounts
    Excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a Health Reimbursement Account or health Flexible Spending Account and from being reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account. Increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the amount used.
  • January 1 2011National Quality Strategy
    Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health

    Implementation: Initial strategy due to Congress by January 1, 2011

  • January 1 2011 Chronic Disease Prevention in Medicaid
    Provides 3-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets.
  • January 1 2011 Medicaid Health Homes
    Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home and provides states taking up the option with 90% federal matching payments for two years for health home-related services.
  • January 1 2011 Medicare Advantage Payment Changes
    Restructures payments to private Medicare Advantage plans by phasing-in payments set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.
  • January 1 2011Medicare Premiums for Higher-Income Beneficiaries
    Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.
  • January 1 2011Center for Medicare and Medicaid Innovation
    Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality.

    Implementation: Center established by January 1, 2011

  • January 1 2011Medicare Prevention Benefits
    Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment.
  • January 1 2011Medicare Payments for Primary Care
    Provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.

    Implementation:January 1, 2011 through December 31, 2015

  • January 1 2011Closing the Medicare Drug Coverage Gap
    Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap. In 2013, begins phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

    Implementation:January 1, 2011 (drug discount) and January 1, 2013 (federal subsidies)

  • Fiscal Year 2011Teaching Health Centers
    Establishes Teaching Health Centers and provides payments for primary care residency programs in community-based ambulatory patient care centers.


  • Fiscal Year 2011Medical Malpractice Grants
    Authorizes $50 million for five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigation.

    Implementation: Authorizes funding beginning fiscal year 2011.

  • October 1 2010Medicaid Community-Based Services
    Provides states with new options for offering home and community-based services through a Medicaid state plan amendment to certain individuals and permits states to extend full Medicaid benefits to individuals receiving home and community-based services under a state plan.
  • September 30 2010Health Care Workforce Commission
    Establishes the National Health Care Workforce Commission to coordinate federal workforce activities and make recommendations on workforce goals and policies and establishes the National Center for Health Workforce Analysis to undertake state and regional workforce data collection and analysis.
  • September 23 2010
    Requires new health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women.

    Implementation: Plan or policy years beginning on or after September 23, 2010

  • September 23 2010Insurance Plan Appeals Process
    Requires new health plans to implement an effective process for allowing consumers to appeal health plan decisions and requires new plans to establish an external review process.

    Implementation: Plan or policy years beginning on or after September 23, 2010

  • September 23 2010Consumer Protections in Insurance
    Prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage, rescinding coverage except in cases of fraud, and from denying children coverage based on pre-existing medical conditions or from including pre-existing condition exclusions for children. Restricts annual limits on the dollar value of coverage (and eliminates annual limits in 2014)

    Implementation: Plan or policy years beginning on or after September 23, 2010

  • September 23 2010Adult Dependent Coverage to Age 26
    Extends dependent coverage for adult children up to age 26 for all individual and group policies.

    Implementation: Plan or policy years beginning on or after September 23, 2010

  • August 16, 2010Review of Health Plan Premium Increases
    Requires the federal government to create a process, in conjunction with states, where insurers have to justify unreasonable premium increases. Provides grants to states for reviewing premium increases.

    Implementation: Plan year 2010

    Stay up to date on all compliance deadlines and changes with Health Care Reform Milestone Manager

  • August 2 2010Expansion of Drug Discount Program Applications Accepted
    Expands eligibility for the 340(B) drug discount program to sole-community hospitals, critical access hospitals, certain children’s hospitals, and other entities.
  • July 1 2010Tax on Indoor Tanning Services
    Imposes a tax of 10% on the amount paid for indoor tanning services.
  • July 1 2010Consumer Website
    Requires the Department of Health and Human Services to develop an internet website to help residents identify health coverage options.
  • July 1 2010New Prevention Council First Report Due
    Creates the National Prevention, Health Promotion and Public Health Council to develop a national prevention, health promotion and public health strategy.
  • July 1 2010Federal Pre-existing Condition Insurance Plan Enrollment Begins
    Creates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. The plan will be operated by the states or the federal government.
  • April 1 2010Medicaid Coverage for Childless Adults
    Creates a state option to provide Medicaid coverage to childless adults with incomes up to 133% of the federal poverty level. (States will be required to provide this coverage in 2014.)
  • March 23 2010New Requirements on Non-profit Hospitals
    Imposes additional requirements on non-profit hospitals to conduct community needs assessments and develop a financial assistance policy and impose a tax of $50,000 per year for failure to meet these requirements.
  • March 23 2010Generic Biologic Drugs
    Authorizes the Food and Drug Administration to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed.
  • March 1 2010Coordinating Care for Dual Eligibles
    Establishes the Federal Coordinated Health Care Office to improve care coordination for dual eligibles (people eligible for both Medicare and Medicaid).
  • January 1 2010Small Business Tax Credits
    Provides tax credits to small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for employees. Phase I (2010-2013): tax credit up to 35% (25% for non-profits) of employer cost; Phase II (2014 and later): tax credit up to 50% (35% for non-profits) of employer cost if purchased through an insurance Exchange for two years.
  • January 1 2010Medicare Beneficiary Drug Rebate
    Provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. Further subsidies and discounts that ultimately close the coverage gap begin in 2011.
  • January 1 2010Reinsurance Program for Retiree Coverage
    Creates a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare.

    Implementation: 90 days following enactment until January 1, 2014

  • Plan Year 2010Review of Health Plan Premium Increases
    Requires the federal government to create a process, in conjunction with states, where insurers have to justify unreasonable premium increases. Provides grants to states for reviewing premium increases.
  • Fiscal Year 2010Health Centers and the National Health Service Corps
    Permanently authorizes the federally qualified health centers and NHSC programs and increases funding for FQHCs and for the NHSC for fiscal years 2010-2015.