Health Reform Rules Issued on Mandatory Prevention Benefits
On July 14, 2010, Interim Final Regulations implementing provisions of the Patient Protection and Affordable Care Act (the “Act”), concerning mandatory preventive health care benefits were issued by the U.S. Departments’ of Health and Human Services, Labor and Treasury. Unless grandfathered (see earlier posts) all insured and self-insured health care plans will be required to offer these benefits at no cost effective on or after September 23, 2010.
Treatments for the prevention of alcohol abuse, depression and obesity are among services that will have no cost-sharing. For adults, the list of covered services includes mammograms, colonosopies and other cancer screnings, diabetes screenings, counseling for tobacco use and prenatal care.
For children, covered services include pediatric visits, vision and hearing screenings, immunizations and obesity screenings.
The cost sharing probihition appy to the specific perventive services provided. Therefore, if the preventive service is billed separately from an office visit, it is the preventive service that will be no cost, not the entire office visit.
If the preventive service is not billed separately from the office visit, if the primary purpose of the visit was to receive the preventive service, the entire visit will be no cost.
On the other hand, plans will not be required to provide coverage for preventive care delivered by an out-of-network provider. If out-of-network preventive services are provided, plans are allowed to impose cost sharing for out-of-network services.
The agencies’ estimate that no cost preventive care will increase the cost of premiums by at least 1.5% per year, although evidence suggests a healthier workforce and higher productivity will make up for the increase over time.
