患者保护与平价医疗法案ACA标题及各章主要内容.doc

患者保护与平价医疗法案ACA标题及各章主要内容
《患者保护及平价医疗法案》（ACA）标题及各章主要内容
《患者保护及平价医疗法案》是奥巴马医改法案的核心内容。因其内容长达900多页，故对法案标题及各章内容予以简要介绍。

第一章标题 为美国人民提供高质量、可承受的医疗卫生服务
主要内容:本章为整个法案的核心内容:一是规定如何提高医疗保险覆盖率,二是规定如何对低收入人群进行经费补助,以便他们能够购买医疗保险。它强调应该由个人、家庭、小企业雇主选择自己想要的医疗卫生服务,减低数以万计的普通家庭和小企业主的医疗保险费用,减轻他们每年自付的医疗卫生费用,将疾病预防项目纳入免费的医疗保险范围。
强调在现有的基础上进行改革,强调政策的连续性,而不是彻底否定过去,一切推倒重来。因此,对于那些喜欢目前的医疗保险的人们,尽可以继续保留他们目前的医疗保险,法案不会强迫这些人改变他们自己的选择。对于那些目前没有医疗保险的人们,可以在公共的、竞争的医疗保险市场上选择适合自己的医疗保险。医疗保险交易中心的设立,使一个个单独的个体联合在一起,从而拥有强大的议价能力,医疗保险公司失去了以前的垄断地位,今后只能凭质量和价格进行竞争。小型企业雇主为员工购买医疗保险,不仅可以在交易中心享受到优惠的保险费用,而且将享受到政府给予的税收优惠政策。
该部法案要求医疗保险公司制定清新的运营规则,杜绝权力滥用现象。禁止保险公司将患病人士排除在医疗保险范围之外。

中文标题 英文标题

第一章为美国人民提供高质量、可承受的医 THIE 1 —QUALITY, AFFORDABLE HEALTH
疗卫生服务 CARE FOR AMERICANS

第一节立即提高美国人民的医疗保险覆盖 Subtitle A — Immediate Improvements in
率 Health Care Coverage for All Americans

1001条款对《公共卫生服务法案》的修订 Sec. 1001. Amendments to the Public Health
Service Act.

1002条款医疗保险中的消费者信息 Sec. 1002. Health insurance consumer information.

1003条款确保消费者物有所值 Sec. 1003. Ensuring that consumers get value for their dollars.

1004条款生效日期 Sec. 1004. Effectives dates.

第二节立即采取行动保持和扩大医疗保险 Subtitle B—Immediate Actions to Preserve
覆盖率 and Expand Coverage.

1101 条款使患有疾病、没有保险的人士立 Sec. 1101. Immediate access to insurance for
即可以获得保险 iminsured individuals with a preexisting conditions.

1102 条款对提前退休人员的再保险 Sec. 1102. Reinsurance for early retirees.

1103条款立即为消费者提供有关信息,使 Sec. 1103. Immediate information that allows
其能选择可承受的保险方案 consumers to identify affordable coverage options.

1104 条款简化管理程序 Sec. 1104.Administrative simplification.

1105 条款生效日期 Sec. 1105. Effective date.

第三节为美国人民提供高质量的医疗保险 Subtitle C—Quality Health Insurance Coverage for All Americans

第一小节医疗保险市场改革 PART I — Health Insurance Market Reforms

1201条款对《公共卫生服务法案》的修订 Sec. 1201. Amendment to the Public Health
Service Act.

第二小节其他条款 PART II — Other Provision

1251条款保留现有医疗服务方案的权利 Sec. 1251. Preservation of right to maintain existing coverage

1252条款比率改革必须对所有医疗保险公Sec. I252. Rating reforms must apply uniformly
司以及团体医疗保险方案一视同仁 to all health insurance issuers and group health plans

1253 条款生效日期 Sec. 1253. Effectives dates.

第四节可供美国人民选择的医疗保险方案 Subtitle D-Available Coverage Choices for All Americans

第一小节设立符合要求的医疗保险方案 PART I — Establishment of Quality Health Plans

1301条款符合要求的医疗保险方案的定义 Sec. 1301. Quality health plan defined.

1302条款需要满足的基本医疗卫生要求 Sec. 1302. Essential health benefits requirements.

1303条款特殊规则 Sec. 1303. Special health benefits requirement.

1304条款相关定义 Sec. 1304. Related definitions

第二小节在医疗保险交易中心的消费 PART Ⅱ—Consumer Choices and Insurance
Competition Through Health Benefit Exchanges

1311 条款可承受的医疗保险方案 Sec. 1311. Affordable choices of health benefit plans.

1312条款消费者的选择 Sec. 1312. Consumer choice.

1313条款资金合理 Sec.1313. Financial integrity.

第三小节州政府可灵活处理医疗保险交易PART III — State Flexibility Relating to Exchanges
中心相关事宜

1321条款州政府可灵活处理医疗保险交易 Sec. 1321. State flexibility in operation and
中心的运作 enforcement of Exchanges and related requirements.

1322条款联邦政府资助设立并运行非营利 Sec. 1322. Federal program to assist
的、会员制的医疗保险公司

1323条款社区医疗保陸方案 Sec. 1323. Community health insurance

1324条款公平性 Sec. 1324. Level playing field.

第四小节州政府可灵活设立其他替代方案 PART IV—State Flexibility to Establish Alterative Programs

1331条款州政府可为不符合医疗救助计划 Sec. 1331. State flexibility to establish basic
的低收入人士设立基本医疗保险方案 health programs for low-income individual not
eligible for Medicaid.

1332 条款关于州政府创新的豁免 Sec. 1332. Waiver for State innovation.

1333条款关于在不止一个州销售保险方案 Sec. 1333. Provision relating to offering of
的规定 plans in more than one state.

第五小节再保险和风险调整 PART V—Reinsurance and Risk Adjustment

1341条款在个人和小团体保险市场的过渡Sec 1341. Transitional reinsurance program for
性再保险项目 individual and small group markets in each state.

1342条款在个人和小团体保险市场设立风Sec. 1342. Establishment of risk corridors for
险通道 plans in individual and small group markets.

1343 条款风险调整 Sec. 1343. Risk adjustment.

第五节美国人民能承受的医疗保险 Subtitle E—Affordable Coverage Choices for
Americans.

第一小节保险费用的税收扣除及分担费用 PARTⅠ— Premium Tax Credits and Cost-sharing
的减低 Reductions

第一小小节保险费用的税收扣除及分担费 Subtitle a — Premium tax credits and cost-sharing用的减低 reductions

1401条款对符合条件的医疗保险申请人的 Sec.1401. Refundable tax providing premium
保险费用给予课退费的纳税扣除 assistance for coverage under a qualified health plan.

1402条款降低符合条件的医疗保险申请人 Sec 1402. Reduced cost-sharing for individual
的分担费用 enrolling in qualified health plans

第二小小节入选标准的确定 Subpart b—eligibility determinations

1411条款确定标准的程序(包括交易中心 Sec. 1411. Procedures for determining
申请人、保险费用纳税扣除、分担费用减低 eligibility for Exchange participation, premium
以及个人责任免除等标准〉 tax credits and reduced cost-sharing, and individual responsibility exemptions.

1412条款预先决定并支付保险费用减的纳 Sec. 1412. Advance determination and payment of税扣除和分担费用减低 premium tax credits and cost-sharing reductions.

1413条款简化保险交易中心、医疗救助计 Sec. 1413. Streamlining of procedures for
划、州儿童医疗保险项目以及其他医疗卫生 enrollment through an exchange and State
补助项目的入选程序 Medicaid, CHIP, and health subsidy programs.

1414 条款公开某些项目的入选要求 Sec. 1414. Disclosures to carry out eligibility
requirements for certain programs.

1415条款及联邦政府以及联邦政府资助项 Sec. 1415. Premium tax credits and reduced
目无关的纳税扣除和分担费用减低 cost-sharing reduction payments disregarded
for Federal and Federally-assisted program.

第二小节小型企业税收扣除 PRAT II — Small Business Tax Credit

1421条款对小型企业的员工提供医疗保险 Sec. 1421. Credit for employee health
的纳税扣除 insurance expenses of small business.

第六节医疗卫生中的各自职责 Subtitle F一 Shared Responsibility for Health Care

第一小节个人职责 PART I —Individual Responsibility

1501条款要求具有最低基本医疗保险的规定 Sec. 1501. Requirement to maintain minimum
essential coverage

1502 条款报告医疗保险方案 Sec. 1502. Reporting of health insurance coverage

第二小节雇主职责 PART II— Employer Responsibility

1511条款大型企业员工自动纳入医疗保险 Sec. 1511. Automatic enrollment for employers.
相关情况

1512条款雇主需要告知员工可供选择的医 Sec. 1512. Employer requirement to inform
疗保险方案 employees of coverage options

1513 条款雇主所分担的职责 Sec. 1513. Shared responsibility for employers.

1514条款报告雇主提供的医疗保险相关情Sec. 1514. Reporting of employer health insurance.

1515 条款通过"自助餐馆〃保险方式提供符 Sec. 1515. Offering of Exchange-participating
合交易中心条件的医疗保险方案 qualified health plans through cafeteria plans.

第七节其他规定 Subtitle G — Miscellaneous Provisions

1551条款定义 Sec. 1551. Definitions

1552条款政府工作透明化 Sec. 1552. Transparency in government

1553条款在协助自杀方面禁止歧视 Sec. 1553. Prohibition against discrimination
on assisted suicide.

1554条款获得治疗 Sec. 1554. Access to therapies

1555条款不参加联邦医疗保险的自由 Sec. 1555. Freedom not to participate in
Federal health insurance programs.

1556条款对某些合适幸存者的公平性 Sec. 1556. Equity for certain eligible survivors.

1557条款非歧视 Sec 1557. Nondiscrimination

1558条款对员工的保护 Sec. 1558. Protection for employees

1559条款监管 Sec. 1559. Oversight

1560条款建设规则 Sec. 1560. Rules of construction

1561条款卫生信息技术纳入标准及方案 Sec. 1561. Health information technology
enrollment standards and protocols

1562 条款修订一致性 Sec. 1562. Conforming amendments,

1563条款参议院关于促进政府财政责任感 Sec. 1563. Sense of the Senate promoting fiscal
的意见(不属于法律强制要求内容) responsibility.

第二章标题 政府项目所扮演的角色
主要内容：本章主要阐述政府医疗保险相关规定。该法案扩大了医疗救助计划的覆盖范围,使各州得到公平对待;保留了原有的州儿童保险项目,简化了个人或家庭的纳入标准;使残疾人士能获得更多的社区医疗卫生保健,使需要长期医疗护理的人士能在家享受医疗卫生保健;赋予州政府创新医疗卫生服务方式的灵活性,更好协调联邦医疗保险及医疗救助计划的相互关系;通过降低处方药的费用,减轻纳税人的负担,通过更多人加入医疗保险,降低纳税人对没有医疗保险人员的变相补助。

第二章政府项目所扮演的角色 TITLE 2 — ROLE OF PUBLIC PROGRAMS

第一节扩大医疗救助计划的覆盖面 Subtitle A — Improved Access to Medicaid

2001条款最低收入人群的医疗救助计划 Sec. 2001. Medicaid coverage for the lowest
income populations.

2002条款适用修正后的总收入衡量标准决定 Sec. 2002. Income eligibility for nonelderly
非老年人的适用性 determined using modified gross income.

2003条款对雇主提供的医疗保险的保险费用 Sec. 2003. Requirement to offer premium
补助 assistance for employer-sponsored insurance.

2004条款对以前收养孩子的医疗救助计划 Sec. 2004. Medicaid coverage for former
foster care children.

2005 条款对某些地方的支付 Sec. 2005. Payments to territories.

2006条款对某些州遭受重大灾难以后对联邦Sec. 2006. Special adjustment to FMAP
医疗补助比例进行特殊调整 determination for certain States recovering from a major disaster.

2007条款医疗救助计划提高基金的废除 Sec. 2007. Medical improvement Fund rescission.

第二节加大对州儿童医疗机构保险项目的支持力度Subtitle B—Enhanced Support for Children's Health Insurance Program

2101条款新增加的州儿童医疗保险项目经费Sec. 2101. Additional federal financial participation for CHIP.

2102 条款技术纠正 Sec. 2102. Technical corrections.

第三节简化医疗救助计划和州儿童医疗保险 Subtitle C — Medicaid and CHIP Enrollment
项目加入程序 Simplification

2201条款简化加入程序以及协调州医疗保险 Sec. 2201. Enrollment Simplification and
交易中心 coordination with State Health Insurance Exchanges.

2202条款允许医院假定患者符合医疗救助计 Sec. 2202. Permitting hospitals to make
划标准 presumptive eligibility determinations for all
Medicaid eligible populations.

第四节提高医疗救助计划服务水平 Subtitle D一Improvement to Medicaid Services

2301条款将独立的产妇分娩服务中心纳入医 Sec. 2301. Coverage for freestanding birth
疗救助计划 center services.

2302 条款对儿童的同时照顾 Sec. 2302. Concurrent care for children.

2303条款计划生育服务的州政府可选择方案Sec. 2303. State eligibility option for family planning services.

2304 条款澄清医学补助的定义 Sec. 2304. Clarification of definition of medical assistance.

第五节提供长期护理及支持服务的州政府新 Subtitle E—New Options for States to
方案 Provide Long-term Services and Supports.

2401 条款社区优先选择方案 Sec. 2401. Community First Choice Option,

2402条款取消家庭及社区为基础服务的障碍 Sec. 2402. Removal of barriers to providing
home and community-based services.

2403条款钱随人走再平衡不范项目 Sec.2403. Money Follows the Person Rebalancing Demonstration.

2404条款防止家庭及社区为基础服务的接收 Sec. 2404. Protection for recipients of home
者的配偶贫困化 and community-based services against spousal improvement.

2405条款扩大对州政府老年及残疾人资源中Sec. 2405. Founding to expand State Aging
心的资助 and Disability Resource Centers.

2406条款参议院关于长期护理的意见(不属 Sec. 2406. Sense of the Senate regarding
于法律强制要求内容) long-term care.

第六节医疗救助计划的处方药范围 Subtitle F—Medicaid Prescription Drug Coverage.

2501条款处方药回扣 Sec. 2501. Prescription drug rebates.

2502条款废止排除某些处方药 Sec. 2502. Elimination of exclusion of coverage of certain drugs.

2503条款提供足够的药房报销 Sec. 2503. Providing adequate pharmacy reimbursement.

第七节医疗救助计划对“不成比例支出费用 Subtitle G—Medicaid Disproportionate
的医院”的支付 Share Hospital (DSH) payments.

2551条款"不成比例支出费用的医院"的支付 Sec. 2551. Disproportionate share hospital
payments.

第八节提高协调符合双重标准的受益人 Subtitle H — Improved Coordination for Dual
Eligible Beneficiaries.

2601 条款五年的示范项目 Sec. 2601. 5-years period for demonstration projects.

2602条款对符合双重标准的受益人提供联邦 Sec. 2602. Providing Federal coverage and
政府的支付协调 payment coordination for dual eligible beneficiaries.

第九节提高医疗救助计划的服务质量和供应 Subtitle I — Improving the Quality of
者貭量 Medicaid for Patients and Providers.

2701 条款成年人健康质量测定 Sec. 2701. Adult health quality measures.

2702条款对医疗卫生相关状况的支付调整 Sec. 2702. Payment Adjustment for Health
Care-Acquired Conditions.

2703条款对患有慢性疾病的参保人州政府可 Sec. 2703. State option to provide health
选择提供“健康之家”服务 homes for enrollees with chronic conditions

2704条款示范项目以评估围绕医院的综合治 Sec. 2704. Demonstration project to evaluate
疗 integrated care around a hospitalization.

2705条款医疗救助计划的全球支付系统示范 Sec. 2705. Medicaid Global Payment System
项目 Demonstration Project.

2706条款儿科医生“负责任的医疗服务组织" Sec. 2706. Pediatric Accountable Care
Organization Demonstration Project.

2707条款医疗救助计划紧急精神病示范项目 Sec. 2707. Medicaid emergency psychiatric
Demonstration project.

第十节改善医疗救助计划和州儿童医疗保险 Subtitle J—Improvements to the Medicaid
项目支付及获得委员会评估影响所有医疗救 and CHIP Payment and Access Commission
助计划受益人的政策 (MACPAC)

2801条款"改善医疗救助计划和州儿童医疗 Sec. 2801. MACPAC assessment of policies
保险项目支付及获得委员会"评估影响所有医 affecting all Medicaid beneficiaries.
疗救助计划受益人的政策

第_|—节保护美国印第安人和阿拉斯加土著 Subtitle K—Protection for American Indians
居民 and Alaska Natives

2901 条款关于印第安人的特殊条款 Sec. 2901. Special rules relating to Indians.

2902条款废止某些印第安医院和诊所关于提 Sec. 2902. Elimination of sunset for
供联邦医疗保险医学保险的"落日"条款 reimbursement for all medicare Part B
services furnished by certain Indian hospitals
and clinics.

第十二节母婴医疗卫生服务 Subtitle L — Maternal and Child Health Services

2951条款母婴及儿童家访项目 Sec. 2951. Maternal, infant, and early childhood home visiting programs.

2952条款支持关于抑郁的教育及研究 Sec. 2952. Support, education, and research for postpartum depression.

2953条款个人责任教育 Sec. 2953. Personal responsibility education.

2954条款回复关于戒酒教育的基金 Sec. 2954. Restoration of information for
abstinence education.

2955条款儿童年龄超过收养和独立生活的过 Sec. 2955. Inclusion of information about the
渡时期应包含指定医疗卫生代理人的重要信 importance of having a health care power of
息 attorney in transition planning for children
aging out of care and independent living programs.

第三章标题 提高医疗卫生服务的质量及效率
主要内容：本章主要阐述改革如何影响医疗卫生服务的质量及效率。通过逐步缩小“联邦医疗保险多纳圈洞”,降低联邦医疗保险参加者的处方药费用