Employee Benefits-Government Issues Regulations On Preventive Care

The Affordable Care Act – the health care reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 -requires health care plans to cover recommended preventive services, without charging a deductible, copayment or co-insurance (that is, without “cost-sharing”). Any health care plan is covered by these requirements, unless the plan is “grandfathered” (that is the plan existed on March 23, 2010 and has not been changed so as to lose grandfather status). The Departments of Health and Human Services, Labor, and the Treasury have now issued regulations, which require covered private health care plans to offer recommended preventive services, and to eliminate cost-sharing for this coverage. The rules in the Affordable Care Act pertaining to preventive care, and the new regulations, apply in plan years beginning on and after September 23, 2010. The government has also issued a Fact Sheet on the new regulations. Here is what the Fact Sheet says on the preventive services that must be covered.

Plans covered by the preventive care rules in the Affordable Care Act and the new regulations must offer coverage of a comprehensive range of preventive services, which are recommended by physicians and other experts, without imposing any cost- sharing requirements. Specifically, these preventive services (including medications) include the following:

–Evidence-based preventive services: The U.S. Preventive Services Task Force, an independent panel of scientific experts, ranks preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a “grade” of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be treated as preventive services that a covered plan must offer.

–Routine vaccines: A set of standard vaccines recommended by the Advisory Committee on Immunization Practices, ranging from routine childhood immunizations to periodic tetanus shots for adults, must be offered by a covered plan.

–Prevention for children: Preventive care for children, recommended under the Bright Futures guidelines developed by the Health Resources and Services Administration with the American Academy of Pediatrics, will be treated as preventive services that a covered plan must offer. This preventive care includes regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

–Prevention for women: Care provided to women under both the Task Force recommendations and new guidelines being developed by doctors, nurses, and scientists, which are expected to be issued by August 1, 2011, will be treated as preventive services for these purposes.

–Updates: The list of preventive services is regularly updated to reflect new scientific and medical advances. As new services are approved, covered health care plans will be required to cover them (with no cost-sharing) for plan years beginning one year later. A full list of the preventive services which must be offered by a covered plan is available at www.HealthCare.gov/center/regulations/prevention.html.