The U.S. Senate passed health care reform legislation by a 60-39 vote on December 24.   Many amendments to the Patient Protection and Affordable Care Act were added shortly before passage to spur innovation and reform in the health care delivery system.   Beyond the health insurance provisions debated over much of the last year, the Senate legislation now contains provisions authorizing:

• Medicaid global payment demonstration projects in up to five states, beginning as early as this fiscal year, involving safety net hospital networks and systems;
• Additional Medicaid demonstration projects in up to eight states, beginning in January 2012, to evaluate the use of bundled payments for hospital and physician services in an episode of care around a hospitalization;
• Accountable care organization (ACO) demonstration projects for pediatric care under Medicaid and CHIP, also beginning in January 2012, under which ACOs meeting performance guidelines would have an opportunity to earn incentive payments and to share in cost savings resulting from more effective care;
• Grants for co-locating primary and specialty care in community mental health settings, beginning with $50 million in grants for the current fiscal year, to address often overlooked physical health needs of individuals with severe and persistent mental illness;
• New state Medicaid options for long term care services and supports for disabled persons, including the Community First Choice Option, which states may implement through a state plan amendment as soon as this October;
• A broadening and an extension through 2016 of Money Follows the Person deinstitutionalization grants under Medicaid, effective 30 days following enactment;
• Medicaid coverage of comprehensive tobacco cessation programs for pregnant women, effective this October, as well as additional Medicaid incentives and grants for the prevention of chronic diseases, effective January 2011.  

The Senate legislation continues to contain state-based health insurance exchanges emulating the success of the Massachusetts Connector. It also provides for a state Medicaid option available in January 2011 for "health homes" comprised of teams of medical professionals dedicated to coordinating and delivering care for individuals with chronic diseases (the "medical homes" concept pioneered in North Carolina and other states), $50 million per year over FY '10-'13 in grants for school-based health centers, and a consumer-directed public long term care insurance option which could begin to collect premiums in 2011 and make direct cash benefit payments to consumers vested in the plan by 2016 to cover community living assistance services and supports.   PCG already has project experience relevant to these and many other provisions of the legislation.   The Senate legislation must now be reconciled, perhaps this month, with legislation passed by the House on November 7.