《患者保護與平價醫(yī)療法案》(ACA)標題及各章主要內(nèi)容

1、患者保護與平價醫(yī)療法案（ACA）標題及各章主要內(nèi)容患者保護與平價醫(yī)療法案是奧巴馬醫(yī)改法案的核心內(nèi)容。因其內(nèi)容長達900多頁，故對法案標題及各章內(nèi)容予以簡要介紹。第一章標題 為美國人民提供高質(zhì)量、可承受的醫(yī)療衛(wèi)生服務主要內(nèi)容:本章為整個法案的核心內(nèi)容:一是規(guī)定如何提高醫(yī)療保險覆蓋率,二是規(guī)定如何對低收入人群進行經(jīng)費補助,以便他們能夠購買醫(yī)療保險。它強調(diào)應該由個人、家庭、小企業(yè)雇主選擇自己想要的醫(yī)療衛(wèi)生服務,減低數(shù)以萬計的普通家庭和小企業(yè)主的醫(yī)療保險費用,減輕他們每年自付的醫(yī)療衛(wèi)生費用,將疾病預防項目納入免費的醫(yī)療保險范圍。強調(diào)在現(xiàn)有的基礎上進行改革,強調(diào)政策的連續(xù)性,而不是徹底否定過去,一切推倒

2、重來。因此,對于那些喜歡目前的醫(yī)療保險的人們,盡可以繼續(xù)保留他們目前的醫(yī)療保險,法案不會強迫這些人改變他們自己的選擇。對于那些目前沒有醫(yī)療保險的人們,可以在公共的、競爭的醫(yī)療保險市場上選擇適合自己的醫(yī)療保險。醫(yī)療保險交易中心的設立,使一個個單獨的個體聯(lián)合在一起,從而擁有強大的議價能力,醫(yī)療保險公司失去了以前的壟斷地位,今后只能憑質(zhì)量和價格進行競爭。小型企業(yè)雇主為員工購買醫(yī)療保險,不僅可以在交易中心享受到優(yōu)惠的保險費用,而且將享受到政府給予的稅收優(yōu)惠政策。該部法案要求醫(yī)療保險公司制定清新的運營規(guī)則,杜絕權力濫用現(xiàn)象。禁止保險公司將患病人士排除在醫(yī)療保險范圍之外。中文標題 英文標題第一章為美國人民

3、提供高質(zhì)量、可承受的醫(yī) THIE 1 QUALITY, AFFORDABLE HEALTH療衛(wèi)生服務 CARE FOR AMERICANS第一節(jié)立即提高美國人民的醫(yī)療保險覆蓋 Subtitle A Immediate Improvements in率 Health Care Coverage for All Americans1001條款對公共衛(wèi)生服務法案的修訂 Sec. 1001. Amendments to the Public HealthService Act.1002條款醫(yī)療保險中的消費者信息 Sec. 1002. Health insurance consumer informat

4、ion.1003條款確保消費者物有所值 Sec. 1003. Ensuring that consumers get value for their dollars.1004條款生效日期 Sec. 1004. Effectives dates.第二節(jié)立即采取行動保持和擴大醫(yī)療保險 Subtitle BImmediate Actions to Preserve覆蓋率 and Expand Coverage.1101 條款使患有疾病、沒有保險的人士立 Sec. 1101. Immediate access to insurance for即可以獲得保險 iminsured individuals

5、with a preexisting conditions.1102 條款對提前退休人員的再保險 Sec. 1102. Reinsurance for early retirees.1103條款立即為消費者提供有關信息,使 Sec. 1103. Immediate information that allows其能選擇可承受的保險方案 consumers to identify affordable coverage options.1104條款簡化管理程序 Sec. 1104.Administrative simplification.1105條款生效日期 Sec. 1105. Effect

6、ive date.第三節(jié)為美國人民提供高質(zhì)量的醫(yī)療保險 Subtitle CQuality Health Insurance Coverage for All Americans第一小節(jié)醫(yī)療保險市場改革 PART I Health Insurance Market Reforms1201條款對公共衛(wèi)生服務法案的修訂 Sec. 1201. Amendment to the Public HealthService Act.第二小節(jié)其他條款 PART II Other Provision1251條款保留現(xiàn)有醫(yī)療服務方案的權利 Sec. 1251. Preservation of right to

7、maintain existing coverage1252條款比率改革必須對所有醫(yī)療保險公Sec. I252. Rating reforms must apply uniformly司以及團體醫(yī)療保險方案一視同仁 to all health insurance issuers and group health plans1253 條款生效日期 Sec. 1253. Effectives dates.第四節(jié)可供美國人民選擇的醫(yī)療保險方案 Subtitle D-Available Coverage Choices for All Americans第一小節(jié)設立符合要求的醫(yī)療保險方案 PART I

8、 Establishment of Quality Health Plans1301條款符合要求的醫(yī)療保險方案的定義 Sec. 1301. Quality health plan defined.1302條款需要滿足的基本醫(yī)療衛(wèi)生要求 Sec. 1302. Essential health benefits requirements.1303條款特殊規(guī)則 Sec. 1303. Special health benefits requirement.1304條款相關定義 Sec. 1304. Related definitions第二小節(jié)在醫(yī)療保險交易中心的消費PART Consumer Cho

9、ices and InsuranceCompetition Through Health Benefit Exchanges1311條款可承受的醫(yī)療保險方案 Sec. 1311. Affordable choices of health benefit plans.1312條款消費者的選擇 Sec. 1312. Consumer choice.1313條款資金合理 Sec.1313. Financial integrity.第三小節(jié)州政府可靈活處理醫(yī)療保險交易PART III State Flexibility Relating to Exchanges中心相關事宜1321條款州政府可靈活處理

10、醫(yī)療保險交易 Sec. 1321. State flexibility in operation and中心的運作 enforcement of Exchanges and related requirements.1322條款聯(lián)邦政府資助設立并運行非營利 Sec. 1322. Federal program to assist的、會員制的醫(yī)療保險公司1323條款社區(qū)醫(yī)療保陸方案 Sec. 1323. Community health insurance1324條款公平性 Sec. 1324. Level playing field.第四小節(jié)州政府可靈活設立其他替代方案 PART IVStat

11、e Flexibility to Establish Alterative Programs1331條款州政府可為不符合醫(yī)療救助計劃 Sec. 1331. State flexibility to establish basic的低收入人士設立基本醫(yī)療保險方案 health programs for low-income individual noteligible for Medicaid.1332 條款關于州政府創(chuàng)新的豁免 Sec. 1332. Waiver for State innovation.1333條款關于在不止一個州銷售保險方案 Sec. 1333. Provision rel

12、ating to offering of的規(guī)定 plans in more than one state.第五小節(jié)再保險和風險調(diào)整 PART VReinsurance and Risk Adjustment1341條款在個人和小團體保險市場的過渡Sec 1341. Transitional reinsurance program for性再保險項目 individual and small group markets in each state.1342條款在個人和小團體保險市場設立風Sec. 1342. Establishment of risk corridors for險通道 plans

13、 in individual and small group markets.1343 條款風險調(diào)整 Sec. 1343. Risk adjustment.第五節(jié)美國人民能承受的醫(yī)療保險 Subtitle EAffordable Coverage Choices forAmericans.第一小節(jié)保險費用的稅收扣除與分擔費用 PART Premium Tax Credits and Cost-sharing的減低 Reductions第一小小節(jié)保險費用的稅收扣除與分擔費 Subtitle a Premium tax credits and cost-sharing用的減低 reductions

14、1401條款對符合條件的醫(yī)療保險申請人的 Sec.1401. Refundable tax providing premium保險費用給予課退費的納稅扣除 assistance for coverage under a qualified health plan.1402條款降低符合條件的醫(yī)療保險申請人 Sec 1402. Reduced cost-sharing for individual的分擔費用 enrolling in qualified health plans第二小小節(jié)入選標準的確定 Subpart beligibility determinations1411條款確定標準的程序

15、(包括交易中心 Sec. 1411. Procedures for determining申請人、保險費用納稅扣除、分擔費用減低 eligibility for Exchange participation, premium以及個人責任免除等標準 tax credits and reduced cost-sharing, and individual responsibility exemptions.1412條款預先決定并支付保險費用減的納 Sec. 1412. Advance determination and payment of稅扣除和分擔費用減低 premium tax credit

16、s and cost-sharing reductions.1413條款簡化保險交易中心、醫(yī)療救助計 Sec. 1413. Streamlining of procedures for劃、州兒童醫(yī)療保險項目以及其他醫(yī)療衛(wèi)生 enrollment through an exchange and State補助項目的入選程序 Medicaid, CHIP, and health subsidy programs.1414 條款公開某些項目的入選要求 Sec. 1414. Disclosures to carry out eligibilityrequirements for certain pro

17、grams.1415條款與聯(lián)邦政府以及聯(lián)邦政府資助項 Sec. 1415. Premium tax credits and reduced目無關的納稅扣除和分擔費用減低 cost-sharing reduction payments disregardedfor Federal and Federally-assisted program.第二小節(jié)小型企業(yè)稅收扣除 PRAT II Small Business Tax Credit1421條款對小型企業(yè)的員工提供醫(yī)療保險 Sec. 1421. Credit for employee health的納稅扣除 insurance expenses

18、of small business.第六節(jié)醫(yī)療衛(wèi)生中的各自職責 Subtitle F一 Shared Responsibility for Health Care第一小節(jié)個人職責 PART I Individual Responsibility1501條款要求具有最低基本醫(yī)療保險的規(guī)定 Sec. 1501. Requirement to maintain minimum essential coverage1502 條款報告醫(yī)療保險方案 Sec. 1502. Reporting of health insurance coverage第二小節(jié)雇主職責 PART II Employer Resp

19、onsibility1511條款大型企業(yè)員工自動納入醫(yī)療保險 Sec. 1511. Automatic enrollment for employers.相關情況1512條款雇主需要告知員工可供選擇的醫(yī) Sec. 1512. Employer requirement to inform療保險方案 employees of coverage options1513 條款雇主所分擔的職責 Sec. 1513. Shared responsibility for employers.1514條款報告雇主提供的醫(yī)療保險相關情Sec. 1514. Reporting of employer health

20、 insurance.1515 條款通過自助餐館保險方式提供符Sec. 1515. Offering of Exchange-participating合交易中心條件的醫(yī)療保險方案 qualified health plans through cafeteria plans.第七節(jié)其他規(guī)定 Subtitle G Miscellaneous Provisions1551條款定義 Sec. 1551. Definitions1552條款政府工作透明化 Sec. 1552. Transparency in government1553條款在協(xié)助自殺方面禁止歧視 Sec. 1553. Prohibit

21、ion against discriminationon assisted suicide.1554條款獲得治療 Sec. 1554. Access to therapies1555條款不參加聯(lián)邦醫(yī)療保險的自由Sec. 1555. Freedom not to participate inFederal health insurance programs.1556條款對某些合適幸存者的公平性Sec. 1556. Equity for certain eligible survivors.1557條款非歧視 Sec 1557. Nondiscrimination1558條款對員工的保護 Sec.

22、 1558. Protection for employees1559條款監(jiān)管 Sec. 1559. Oversight1560條款建設規(guī)則 Sec. 1560. Rules of construction1561條款衛(wèi)生信息技術納入標準與方案 Sec. 1561. Health information technologyenrollment standards and protocols1562 條款修訂一致性 Sec. 1562. Conforming amendments,1563條款參議院關于促進政府財政責任感 Sec. 1563. Sense of the Senate promo

23、ting fiscal的意見(不屬于法律強制要求內(nèi)容) responsibility.第二章標題 政府項目所扮演的角色主要內(nèi)容：本章主要闡述政府醫(yī)療保險相關規(guī)定。該法案擴大了醫(yī)療救助計劃的覆蓋范圍,使各州得到公平對待;保留了原有的州兒童保險項目,簡化了個人或家庭的納入標準;使殘疾人士能獲得更多的社區(qū)醫(yī)療衛(wèi)生保健,使需要長期醫(yī)療護理的人士能在家享受醫(yī)療衛(wèi)生保健;賦予州政府創(chuàng)新醫(yī)療衛(wèi)生服務方式的靈活性,更好協(xié)調(diào)聯(lián)邦醫(yī)療保險與醫(yī)療救助計劃的相互關系;通過降低處方藥的費用,減輕納稅人的負擔,通過更多人加入醫(yī)療保險,降低納稅人對沒有醫(yī)療保險人員的變相補助。第二章政府項目所扮演的角色 TITLE 2 RO

24、LE OF PUBLIC PROGRAMS第一節(jié)擴大醫(yī)療救助計劃的覆蓋面 Subtitle A Improved Access to Medicaid2001條款最低收入人群的醫(yī)療救助計劃 Sec. 2001. Medicaid coverage for the lowestincome populations.2002條款適用修正后的總收入衡量標準決定 Sec. 2002. Income eligibility for nonelderly非老年人的適用性 determined using modified gross income.2003條款對雇主提供的醫(yī)療保險的保險費用 Sec. 20

25、03. Requirement to offer premium補助 assistance for employer-sponsored insurance.2004條款對以前收養(yǎng)孩子的醫(yī)療救助計劃 Sec. 2004. Medicaid coverage for formerfoster care children.2005 條款對某些地方的支付 Sec. 2005. Payments to territories.2006條款對某些州遭受重大災難以后對聯(lián)邦Sec. 2006. Special adjustment to FMAP醫(yī)療補助比例進行特殊調(diào)整 determination for

26、certain States recovering from a major disaster.2007條款醫(yī)療救助計劃提高基金的廢除 Sec. 2007. Medical improvement Fund rescission.第二節(jié)加大對州兒童醫(yī)療機構保險項目的支持力度Subtitle BEnhanced Support for Childrens Health Insurance Program2101條款新增加的州兒童醫(yī)療保險項目經(jīng)費Sec. 2101. Additional federal financial participation for CHIP.2102 條款技術糾正 Se

27、c. 2102. Technical corrections.第三節(jié)簡化醫(yī)療救助計劃和州兒童醫(yī)療保險 Subtitle C Medicaid and CHIP Enrollment項目加入程序 Simplification2201條款簡化加入程序以及協(xié)調(diào)州醫(yī)療保險 Sec. 2201. Enrollment Simplification and交易中心 coordination with State Health Insurance Exchanges.2202條款允許醫(yī)院假定患者符合醫(yī)療救助計 Sec. 2202. Permitting hospitals to make劃標準 presum

28、ptive eligibility determinations for allMedicaid eligible populations.第四節(jié)提高醫(yī)療救助計劃服務水平 Subtitle D一Improvement to Medicaid Services2301條款將獨立的產(chǎn)婦分娩服務中心納入醫(yī) Sec. 2301. Coverage for freestanding birth療救助計劃 center services.2302 條款對兒童的同時照顧 Sec. 2302. Concurrent care for children.2303條款計劃生育服務的州政府可選擇方案Sec. 230

29、3. State eligibility option for family planning services.2304 條款澄清醫(yī)學補助的定義 Sec. 2304. Clarification of definition of medical assistance.第五節(jié)提供長期護理與支持服務的州政府新 Subtitle ENew Options for States to方案 Provide Long-term Services and Supports.2401 條款社區(qū)優(yōu)先選擇方案 Sec. 2401. Community First Choice Option,2402條款取消家庭

30、與社區(qū)為基礎服務的障礙 Sec. 2402. Removal of barriers to providinghome and community-based services.2403條款錢隨人走再平衡不范項目 Sec.2403. Money Follows the Person Rebalancing Demonstration.2404條款防止家庭與社區(qū)為基礎服務的接收 Sec. 2404. Protection for recipients of home者的配偶貧困化 and community-based services against spousal improvement.2

31、405條款擴大對州政府老年與殘疾人資源中Sec. 2405. Founding to expand State Aging心的資助 and Disability Resource Centers.2406條款參議院關于長期護理的意見(不屬 Sec. 2406. Sense of the Senate regarding于法律強制要求內(nèi)容) long-term care.第六節(jié)醫(yī)療救助計劃的處方藥范圍 Subtitle FMedicaid Prescription Drug Coverage.2501條款處方藥回扣 Sec. 2501. Prescription drug rebates.250

32、2條款廢止排除某些處方藥 Sec. 2502. Elimination of exclusion of coverage of certain drugs.2503條款提供足夠的藥房報銷 Sec. 2503. Providing adequate pharmacy reimbursement.第七節(jié)醫(yī)療救助計劃對“不成比例支出費用 Subtitle GMedicaid Disproportionate的醫(yī)院”的支付 Share Hospital (DSH) payments.2551條款不成比例支出費用的醫(yī)院的支付 Sec. 2551. Disproportionate share hospi

33、talpayments.第八節(jié)提高協(xié)調(diào)符合雙重標準的受益人Subtitle H Improved Coordination for DualEligible Beneficiaries.2601 條款五年的示范項目 Sec. 2601. 5-years period for demonstration projects.2602條款對符合雙重標準的受益人提供聯(lián)邦 Sec. 2602. Providing Federal coverage and政府的支付協(xié)調(diào) payment coordination for dual eligible beneficiaries.第九節(jié)提高醫(yī)療救助計劃的服務質(zhì)

34、量和供應 Subtitle I Improving the Quality of者貭量 Medicaid for Patients and Providers.2701 條款成年人健康質(zhì)量測定 Sec. 2701. Adult health quality measures.2702條款對醫(yī)療衛(wèi)生相關狀況的支付調(diào)整 Sec. 2702. Payment Adjustment for HealthCare-Acquired Conditions.2703條款對患有慢性疾病的參保人州政府可 Sec. 2703. State option to provide health選擇提供“健康之家”服務

35、homes for enrollees with chronic conditions2704條款示范項目以評估圍繞醫(yī)院的綜合治 Sec. 2704. Demonstration project to evaluate療 integrated care around a hospitalization.2705條款醫(yī)療救助計劃的全球支付系統(tǒng)示范 Sec. 2705. Medicaid Global Payment System項目 Demonstration Project.2706條款兒科醫(yī)生“負責任的醫(yī)療服務組織 Sec. 2706. Pediatric Accountable CareO

36、rganization Demonstration Project.2707條款醫(yī)療救助計劃緊急精神病示范項目 Sec. 2707. Medicaid emergency psychiatricDemonstration project.第十節(jié)改善醫(yī)療救助計劃和州兒童醫(yī)療保險 Subtitle JImprovements to the Medicaid項目支付與獲得委員會評估影響所有醫(yī)療救 and CHIP Payment and Access Commission助計劃受益人的政策 (MACPAC)2801條款改善醫(yī)療救助計劃和州兒童醫(yī)療 Sec. 2801. MACPAC assessme

37、nt of policies保險項目支付與獲得委員會評估影響所有醫(yī) affecting all Medicaid beneficiaries.療救助計劃受益人的政策第_|節(jié)保護美國印第安人和阿拉斯加土著 Subtitle KProtection for American Indians居民 and Alaska Natives2901 條款關于印第安人的特殊條款 Sec. 2901. Special rules relating to Indians.2902條款廢止某些印第安醫(yī)院和診所關于提 Sec. 2902. Elimination of sunset for供聯(lián)邦醫(yī)療保險醫(yī)學保險的落日

38、條款 reimbursement for all medicare Part Bservices furnished by certain Indian hospitalsand clinics.第十二節(jié)母嬰醫(yī)療衛(wèi)生服務 Subtitle L Maternal and Child Health Services2951條款母嬰及兒童家訪項目 Sec. 2951. Maternal, infant, and early childhood home visiting programs.2952條款支持關于抑郁的教育與研究 Sec. 2952. Support, education, and re

39、search for postpartum depression.2953條款個人責任教育 Sec. 2953. Personal responsibility education.2954條款回復關于戒酒教育的基金 Sec. 2954. Restoration of information for abstinence education.2955條款兒童年齡超過收養(yǎng)和獨立生活的過 Sec. 2955. Inclusion of information about the渡時期應包含指定醫(yī)療衛(wèi)生代理人的重要信 importance of having a health care power

40、of息 attorney in transition planning for childrenaging out of care and independent living programs.第三章標題 提高醫(yī)療衛(wèi)生服務的質(zhì)量與效率主要內(nèi)容：本章主要闡述改革如何影響醫(yī)療衛(wèi)生服務的質(zhì)量與效率。通過逐步縮小“聯(lián)邦醫(yī)療保險多納圈洞”,降低聯(lián)邦醫(yī)療保險參加者的處方藥費用;激勵醫(yī)生、護士和醫(yī)院提高醫(yī)療服務質(zhì)量和減少不必要的錯誤;通過豐富欠發(fā)達地區(qū)的醫(yī)療衛(wèi)生資源,促進農(nóng)村地區(qū)的居民獲得更好的醫(yī)療衛(wèi)生服務;通過停止對保險公司的過分慷慨費用支付,將為納稅人節(jié)省幾百億美元;通過提高醫(yī)療保險的覆蓋率,使人們身

41、體更加健康,進一步降低聯(lián)邦醫(yī)療保險費用;成立醫(yī)生與醫(yī)療衛(wèi)生專家組成的委員會,就進一步提高醫(yī)療衛(wèi)生服務質(zhì)量和減低醫(yī)療衛(wèi)生費用獻計獻策。第三章提高醫(yī)療衛(wèi)生服務的質(zhì)量與效率 TITLE 3 IMPROVING THE QUALITY ANDEFFICIENCY OF HEALTH CARE第一小節(jié)改革醫(yī)療衛(wèi)生服務體系 Subtitle A -Transforming the Health Care Delivery System第一小小節(jié)將聯(lián)邦醫(yī)療保險質(zhì)量與費用掛鉤 PART I Linking Payment to QualityOutcomes Under the Medicare Progra

42、m3001條款醫(yī)院基于價值基礎的購買項目Sec3001. Hospital Value-Based purchasing program.3002條款提高醫(yī)生質(zhì)量報告體系 Sec.3002. Improvement to the physician quality reporting system.3003條款提高醫(yī)生反饋項目 Sec.3003. Improvements to the physicianfeedback program.3004條款長期護理醫(yī)院、康復醫(yī)院以及臨終 Sec.3004. Quality reporting for long-term關懷項目的質(zhì)量報告 care H

43、ospitals, inpatient rehabilitationhospitals, and hospice programs.3005條款 PPS 豁免的癌癥醫(yī)院的質(zhì)量報告 Sec. 3005. Quality reporting for PPS-exemptcancer hospitals.3006條款關于護理機構和家庭保健機構價值 Sec. 3006. Plans for a Value-Based基礎上的采購項目 purchasing program for skilled nursingfacilities and home health agencies.3007條款醫(yī)生收費表

44、在價值基礎上進行調(diào)整 Sec. 3007. Value-Based payment modifierunder the physician fee schedule.3008條款對醫(yī)院某些疾病的支付調(diào)整 Sec. 3008. Payment adjustment forconditions acquired in hospitals.第二小小節(jié)提高醫(yī)療衛(wèi)生服務質(zhì)量的國家戰(zhàn)略 PART IINational Strategy to Improvement Health Care Quality3011 條款國家戰(zhàn)略 Sec 3011. National Strategy. 3012條款關于醫(yī)療衛(wèi)

45、生服務的質(zhì)量的跨部門 Sec. 3012. Interagency Working Group on工作組 Health Care Quality.3013 條款發(fā)展質(zhì)量測評 Sec. 3013. Quality measure development.3104 條款質(zhì)量測評 Sec. 3014. Quality measurement.3015 條款數(shù)裾收集與公開報道 Sec. 3015. Data collection; public reporting.第三小小節(jié)鼓勵發(fā)展新的患者服務模式 PART III Encouraging Development of newPatient Car

46、e Models.3021條款在聯(lián)邦醫(yī)療保險與醫(yī)療救助計劃中 Sec. 3021. Established of Center for心建立聯(lián)邦醫(yī)療保險與醫(yī)療救助計劃創(chuàng)新中 Medicare and Medicaid Innovation within心 CMS.3022條款聯(lián)邦醫(yī)療保險分享節(jié)省費用項目 Sec. 3022. Medicare shared saving program.3023條款關于捆綁式支付費用的國家試點項目 Sec. 3023. National pilot program onpayment bundling.3024條款獨立在假示范項目 Sec. 3024. Ind

47、ependence at home demonstration program.3025條款減少再次入院項目 Sec. 3025. Hospital readmissions reduction program.3026條款以社區(qū)為基礎的護理過渡項目 Sec.3026.Community-Based Care Transitions Program.3027條款延長收入分成示范項目 Sec. 3027. Extension of gainsharing demonstration.第二小節(jié)提高聯(lián)邦醫(yī)療保險服務質(zhì)量和提供 Subtitle BImproving Medical for Patients者質(zhì)量 and Providers第一小小節(jié)確保參加人