Affordable Care Act (ACA)
The new health care law offers a host of coverage changes and opportunities beginning in 2014. Blue Cross and Blue Shield of Montana (BCBSMT) is committed to implementing coverage changes to comply with ACA requirements and to better meet the needs and expectations of you and your patients.
This section offers updated information and resources to keep you informed of the issues potentially affecting the administrative and patient care aspects of your practice. We invite you to refer back to this page often for ongoing information on ACA provisions.
Initial provisions of the Affordable Care Act (ACA) were implemented in March 2010. Additional provisions, including the individual mandate to have health coverage beginning January 1, 2014, will continue to be enacted in subsequent phases through 2018.
Under the multiphase initiative known as Administrative Simplification, health plans are required to implement new operating rules to promote greater uniformity in the exchange of electronic health care information. BCBSMT implemented operating rules for the first and second phases in January 2013. System changes are currently in progress for the next phase.
As a result of the new law, individuals and families will have more options for managing their health care needs with expanded coverage for women, children and individuals with pre-existing conditions. Other provisions offer greater access to preventive care services with no cost sharing, and guarantees coverage of essential health benefits in our individual and small group insurance products.
Risk Adjustment, under ACA, identifies the differences in health care risk among specific patients. The goal of the Risk Adjustment methodology is to provide an objective way to compare care and cost performance. Providers play an important role. Risk Adjustment is one of the methods that helps payers and providers focus on quality and service.