Flat-Fee Health Care Option Provides Patients and Small Businesses Lower-Cost Alternative to Traditional Insurance Plans

[Guest guest]

This will be interesting.

I'm sure Qliance.com meets the criteria that will be set forth...-------------------------------------------------------------------------------------------------

TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MEDICAL HOME PLANS.—The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.

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Qliance should fit this definition.

 

So the Direct Primary Care Medical Home (ie Qliance -- ?any direct pay practice) just has to coordinate with the Qualified Health Plan.

 

Wonder how that will work in the end -- sounds like you might have to be a larger group to make that work.

 

Anyways -- Check this out...

 

http://newsfeedresearcher.com/data/articles_m13/health-care-insurance.html

 

SEATTLE, WA -- 03/23/10 -- A relatively little-known provision in H.R. 3590, the Patient Protection and Affordable Care Act, signed into law by the President today, creates an affordable new choice for individuals and businesses by allowing flat-fee direct primary care practices, commonly referred to as " medical homes, " to compete within the state-based insurance exchanges where many Americans and small businesses will be able to shop for health coverage beginning in 2014. This provision enables Americans to elect a more affordable health care option to traditional insurance plans -- an alternative in which patients and/or employers pay a flat monthly fee directly to a primary care provider for all primary and preventive care, chronic disease management and care coordination throughout the entire health care system. Under the new law, a flat-fee direct primary care medical home membership can be bundled with a new, lower-cost " wrap-around " insurance plan that covers unpredictable and expensive services outside its scope, such as specialist care, hospital stays or emergency room visits. [3]

 

http://www.dpcare.org/hr3590

 

HEALTH CARE LEGISLATION PAVES WAY FOR DIRECT PRIMARY CARE MEDICAL HOMES TO COMPETE IN INSURANCE EXCHANGES 

Flat-Fee Health Care Option Provides Patients and Small Businesses - Lower-Cost Alternative to Traditional Insurance Plans

SEATTLE (March 23, 2010) – A relatively little-known provision in H.R. 3590, the Patient Protection and Affordable Care Act, signed into law by the President today, creates an affordable new choice for individuals and businesses by allowing flat-fee direct primary care practices, commonly referred to as “medical homes,” to compete within the state-based insurance exchanges where many Americans and small businesses will be able to shop for health coverage beginning in 2014. 

This provision enables Americans to elect a more affordable health care option to traditional insurance plans – an alternative in which patients and/or employers pay a flat monthly fee directly to a primary care provider for all primary and preventive care, chronic disease management and care coordination throughout the entire health care system. Under the new law, a flat-fee direct primary care medical home membership can be bundled with a new, lower-cost “wrap-around” insurance plan that covers unpredictable and expensive services outside its scope, such as specialist care, hospital stays or emergency room visits.

Snip/snip

 

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Forgot to post this in the last e-mail.

 

http://www.kaiserhealthnews.org/Stories/2009/June/02/Doctors.aspx

 

Family physician H. Lee Adkins of Fort Myers, Fla., recently launched a novel plan to counter the growing no-show rate among patients with chronic illnesses: a $75-per-month fee that entitles patients to a basic package of services including more than a dozen office visits per year, simple lab tests and many vaccinations. Patients are required to sign a one-year contract.

Why $75? " That's the same amount people spend on a monthly cable bill, " Adkins says.

He refers patients who need colonoscopies or mammograms to specialists who provide them at reduced cost. And he sends those who need medication to Wal-Mart, Target or other chain stores that offer steep discounts on certain drugs.

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http://finance.yahoo.com/news/Health-Care-Legislation-Paves-iw-217336039.html?x=0 & .v=1

 

Health Care Legislation Paves Way for Direct Primary Care Medical Homes to Compete in Insurance Exchanges

Flat-Fee Health Care Option Provides Patients and Small Businesses Lower-Cost Alternative to Traditional Insurance Plans SEATTLE, WA--(Marketwire - 03/23/10) - A relatively little-known provision in H.R. 3590, the Patient Protection and Affordable Care Act, signed into law by the President today, creates an affordable new choice for individuals and businesses by allowing flat-fee direct primary care practices, commonly referred to as " medical homes, " to compete within the state-based insurance exchanges where many Americans and small businesses will be able to shop for health coverage beginning in 2014.

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http://www.alston.com/files/docs/AB%20Health%20Care%20Reform%20Side%20by%20Side_%20Senate%20Bill%20and%20Reconciliation%20Bill_3_19_10.pdf

Qualified Health Plan Defined. Defines “qualified health benefit plan” as a plan that meets criteria for certification by Exchanges where it is offered; provides the essential health benefits package; and is offered by a licensed insurer that agrees to

(1) offer at least one qualified health plan in the “silver” level and at least one plan in the “gold” level in each Exchange through which the plan is offered, (2) agrees to charge the same premium rate for each qualified health plan whether offered in or outside of the Exchange, and

(3) complies with federal regulations. Includes a COOP plan or a multi-State plan. Permits a qualified health benefit plan to provide coverage through a qualified direct primary care medical home plan. Permits a qualified health benefit plan to vary premiums by rating area.

(Sec. 1301)

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills & docid=f:h3590enr.txt.pdf

SEC. 1301. QUALIFIED HEALTH PLAN DEFINED.

(a) QUALIFIED HEALTH PLAN.—In this title:

(1) IN GENERAL.—The term ‘‘qualified health plan’’ means a health plan that—

(A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in section 1311© issued or recognized by each Exchange through which such plan is offered;

( provides the essential health benefits package described in section 1302(a); and

© is offered by a health insurance issuer that— (i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title;

(ii) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;(iii) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and(iv) complies with the regulations developed by the Secretary under section 1311(d) and such other requirements as an applicable Exchange may establish.

(2) INCLUSION OF CO-OP PLANS AND COMMUNITY HEALTH

INSURANCE OPTION.—Any reference in this title to a qualified health plan shall be deemed to include a qualified health plan offered through the CO-OP program under section 1322 or a community health insurance option under section 1323, unless specifically provided for otherwise.

( TERMS RELATING TO HEALTH PLANS.—In this title:

(1) HEALTH PLAN.—

(A) IN GENERAL.—The term ‘‘health plan’’ means health insurance coverage and a group health plan. ( EXCEPTION FOR SELF-INSURED PLANS AND MEWAS.—

Except to the extent specifically provided by this title, the term ‘‘health plan’’ shall not include a group health plan or multiple employer welfare arrangement to the extent the plan or arrangement is not subject to State insurance regulation under section 514 of the Employee Retirement Income Security Act of 1974.

(2) HEALTH INSURANCE COVERAGE AND ISSUER.—The terms ‘‘health insurance coverage’’ and ‘‘health insurance issuer’’ have the meanings given such terms by section 2791( of the Public Health Service Act.

(3) GROUP HEALTH PLAN.—The term ‘‘group health plan’’ has the meaning given such term by section 2791(a) of the Public Health Service Act.

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SEC. 10104. AMENDMENTS TO SUBTITLE D.

(a) Section 1301(a) of this Act is amended by striking paragraph (2) and inserting the following:

‘‘(2) INCLUSION OF CO–OP PLANS AND MULTI-STATE QUALIFIED HEALTH PLANS.—Any reference in this title to a qualified health plan shall be deemed to include a qualified health plan offered through the CO–OP program under section 1322, and a multi-State plan under section 1334, unless specifically provided for otherwise.

‘‘(3) TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MEDICAL HOME PLANS.—The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.

Locke, MD