HHS: New health plans must cover preventive care, eliminate cost-sharing

According to new regulations issued Wednesday by the departments of Health and Human Services, Labor and the Treasury, private health plans beginning on or after Sept. 23 must cover evidence-based preventive care and eliminate cost-sharing requirements.

“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,” Kathleen Sebelius, HHS secretary, said in a press release.

According to the HHS, preventive services are used in America at about half the recommended rate, and cost-sharing in the form of deductibles, coinsurance and copayments are partially to blame. The new regulations require coverage for those preventive services with strong scientific evidence and the elimination of cost-sharing for services delivered by a network provider. In addition, the following recommendations are included:

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 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 covered under these rules.
Routine vaccines: Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices, ranging from routine childhood immunizations to periodic tetanus shots for adults.
Prevention 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 years 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 screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.
Prevention 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 Aug. 1, 2011.

Other facets of the Affordable Care Act that support prevention include the formation of the National Prevention, Health Promotion and Public Health Council to help develop a national prevention strategy; the establishment of a Prevention and Public Health Fund to invest in prevention projects; and, beginning this year, policies to boost the number of primary care providers to guarantee access to preventive services, according to the HHS.

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