• Fines of $325 per individual (or 2% of income if this is greater) or $975 per family for not carrying health insurance
• Employers with 100 or more full-time employees must provide affordable coverage to 70% of employees or face penalties of $2,000 per employee at the start of their plan year in 2015.  Employers with 50 to 100 full-time employees face penalties in 2016
• Employers are responsible for notifying employees of their rights under the ACA, and for keeping all coverage elections and subsidy certification notices confidential
• Medicare penalties begin for failing to demonstrate meaningful use
• Medicaid increases to primary care providers end
• Children's Health Insurance Program (CHIP) funding expires in September
• DSH Program (Medicaid's Disproportionate Share Hospital Program, which gives funds to hospitals that serve a large number of Medicaid and uninsured individuals) begins funding cuts October 1.  The program will be cut $17 billion by 2020

Although not related to the ACA, other legislation mandates use of ICD-10 code sets effective October 1, 2015.

• Pre-existing condition exclusions abolished
• Insurer rate setting regulated
• Insurers may continue to renew current enrollees in non-grandfathered plans that do not meet ACA minimum requirements.  This "transition relief policy" was enacted in November 2013 in response to large numbers of policies not being renewed by insurers.  Transition relief applies to all policies beginning on or before October 1, 2016
• Small business tax credits for health insurance purchased for employees continues.  An employer with less than 25 equivalent full-time workers which pays 50% of the cost of coverage, and pays $50,00 or less in average annual wages per full-time employee is eligible for the tax credit
• Colorado expands Medicaid eligibility.  Family's of four earning up to $30,000 a year now eligible for Medicaid.  This is expected to add 160,000 Medicaid insured patients in Colorado in 2014
• Subsidies available to purchase insurance.  Family's of four earning less than $94,200 annually are eligible.  Subsidies equal the difference between the cost of a plan in that state and a percentage of income 
• Individuals required to purchase health insurance or face minimal fines

This was the last year to begin participation in an EHR Incentive Program.  See "2009 was Meaningful" at right for this program, created by the American Recovery and Reinvestment Act (ARRA) in 2009. 

• Insurers mandated to spend 80% of insurance premiums on medical services
• Medicare offers some free preventive services
• OTC drugs without a prescription no longer reimbursed for FSA, HRA and HSA
• Prescription discounts for brand-name drugs for those in the "donut hole"
• Applications for Pioneer ACO's made this year, for implementation in 2012

Stage 3

Slated to begin in 2016, the proposed rule for Stage 3, now being reviewed by the Office of Management and Budget before publication in the Federal Register, focuses on improving health outcomes and furthering interoperability. It also explains the criteria eligible professionals and eligible hospitals must meet to demonstrate meaningful use under the program. The meaningful use program's reporting period, structure, and timelines will also change in the new proposed rule.

Stage 2

2014 was the first year those successfully attesting to Stage 1 meaningful use could move forward to Stage 2, whose goals were to exchange health information (captured in Stage 1) between providers and provide access to patients.  Click to continue...

Stage 1

Begun in 2011, the goals of this stage were to capture and share data.

Meaningful use was defined as meeting 14 core objectives and at least 5 menu objectives. 

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Colorado Health Insurance Exchange

5 things about health reform in 2015