Not too far in the future Affordable Care Act implementations will be targeting transparency in the health care industry, focusing on payments to health care providers and physician ownership. The Department of Health and Human Services (HHS) will have reporting requirements for manufacturers, to be aware of potential conflicts of interest. The Act will also be introducing more tax changes in 2013 to help individuals and revenue taxes to help fund the provisions in the Act. Below is a summary of what to expect in 2013.

Transparency

The Affordable Care Act will require manufacturers to submit transparency reports to HHS, beginning in 2013. The reports--on payments to health care practitioners/entities, will be required every 90 days. The information in these reports will include:

--The name of the health care practitioner to whom any payment or transfer of value is given;

--The amount of payment or transfer of value;

--Description of the payment/transfer of value (i.e., cash, stock, services);

--A description of the nature of the payment, i.e. consulting fees; honoraria; gift; entertainment; food; travel; education; research; royalty or license; current or prospective ownership; direct compensation for serving as faculty or as a speaker for a medical education program; and

--If the payment or other transfer of value is related to marketing, education, or research specific to a covered drug, device, biological, or medical supply.

In addition, applicable manufacturers and applicable group purchasing organizations will be required to report to HHS information regarding any physician or a physician's family member's ownership or investment interest in the manufacturer/group purchasing organization during the preceding year. That includes the dollar amount invested by each physician holding the ownership or investment interest; the value and terms of each ownership or investment interest; and any payment or other transfer of value provided to a physician holding the ownership or investment interest.

The penalty for noncompliance in reporting is a civil fine between $1,000 and $10,000 for each payment, transfer of value, ownership, or investment interest not reported as required. The penalties will not exceed $150,000. However, any manufacturer or group purchasing organization knowingly failing to submit the information required in a timely manner may receive a civil money penalty between $10,000 and $100,000, for each failure to report.


Tax Changes

In 2013 there will be an increase in the threshold for claiming itemized deductions for medical expenses from 7.5 percent to 10 percent. For those over 65, itemized deductions for medical expenses can be claimed at 7.5 of the adjusted gross income in 2016. Other tax changes include:

--Implementation of the medical device excise tax--a 2.3 percent excise tax on the sale of any taxable medical device. Certain items are exempt from the tax: eye glasses, contact lenses, hearing aids, and any device generally purchased by the public at retail;

--Higher-wage workers will have an increased hospital tax rate at 0.9 percent on wages over $200,000 for an individual, or $250,000 for joint married filers. The tax also includes a 3.8 percent assessment on net investment income;

--The amount of contributions to a health flexible savings account will be limited to $2,500 per year, with cost of living adjustments annually; and

--Elimination of the employer deduction of Medicare Part D subsidies to maintain prescription drug plans for eligible retirees.

In Other News

In other health reform news, HHS has announced $46 million in grants to help states improve their processes for reviewing health insurance premium increases. According to Healthcare.gov, 45 states and the District of Columbia applied for the grants. Each grantee will receive $1 million in funds. The improvements that states are planning include:

--Using additional legislative authority in creating stronger programs to review or require advance approval of proposed health insurance premium increases;

--Expanding the scope of current health insurance review, such as pre-approving rate increases for additional health insurance products in the state;

--Requiring insurers to report more information in a standardized process to assist in the evaluation of proposed premium increases, and improving transparency;

--Ensuring more information on health insurance premium review will be made available to the consumer in an accessible manner; and

--Developing and improving existing technology for data sharing and giving information to consumers.

The full list of state plans for overhauling their review processes can be found here.