Digestive Diseases News Winter 2011
Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care
The U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury issued new regulations in July requiring new private health plans to cover evidence-based preventive services and eliminate cost-sharing requirements for such services. The new rules will help Americans gain easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children.
“Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs,” said HHS Secretary Kathleen Sebelius. “From the Recovery Act to the First Lady’s Let’s Move Campaign to the Affordable Care Act, the Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy.”
Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for seven of 10 deaths among Americans each year and account for 75 percent of the nation’s health spending—and often are preventable. Nationally, Americans use preventive services at about half the recommended rate. An estimated 11 million children and 59 million adults have private insurance that does not adequately cover immunization, for instance. Studies have shown that cost sharing, including deductibles, coinsurance, and copayments, reduces the likelihood that people will use preventive services.
“Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high blood pressure,” said First Lady Michelle Obama. “And good [preventive] care will also help tackle an issue that is particularly important to me as First Lady and as a mother—and that is the epidemic of childhood obesity in America today. These are important tools, and now it’s up to us to use them.”
“One of the best ways to improve the quality of your life—and control health care costs—is to prevent illness in the first place,” said Second Lady Jill Biden. “Focusing on prevention and early treatment makes more sense than trying to play catch-up with a potentially deadly disease. Quite simply, these [preventive] services will save lives.”
Under the recently issued regulations, new health plans beginning on or after September 23, 2010, must cover preventive services that have strong scientific evidence of their health benefits, and these plans may no longer charge a patient a copayment, coinsurance, or deductible for these services when they are delivered by a network provider. Specifically, these recommendations include the following:
- Evidence-based preventive services. The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a “grade” of A or B—such as tobacco cessation counseling and screenings for breast and colon cancer, vitamin deficiencies during pregnancy, diabetes, high cholesterol, and high blood pressure—will be covered under these rules.
- Routine vaccines. Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices. Such vaccines range from routine childhood immunizations to periodic tetanus shots for adults.
- Preventive care for children. Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These guidelines provide pediatricians and other health care professionals with recommendations on the services they should provide to children from birth to age 21 to keep them healthy and improve their chances of becoming healthy adults. The types of services that will be covered include regular pediatrician visits, vision and hearing screenings, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.
- Preventive care for women. Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by August 1, 2011.
More information about the Affordable Care Act’s new rules on preventive care can be found at www.hhs.gov/healthcare/facts/timeline/index.html.
The regulations can be found at www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/index.html.
NIH Publication No. 11–4552
Page last updated March 18, 2013