AGENCIES ISSUE REGULATIONS ON PREVENTIVE SERVICES

On Monday, July 19, 2010, the Department of Health and Human Services (HHS) along with the IRS and the Employee Benefits Security Administration released interim final rules relating to coverage of preventive services under the Affordable Care Act.

These rules require health plans (including Medicare and Medicaid) and health insurance issuers to cover recommended preventive services without imposing cost-sharing requirements in the form of deductibles, co-insurance or co-payments when preventive services are delivered by a network provider.  Plans will still be able to impose these cost-sharing requirements on preventive services delivered by a non-network provider.  These rules will take effect for plan years beginning on or after September 23, 2010 (with the exception of grandfathered plans).

The proposed rules will apply to four categories of preventive services:

1. Evidence-based services rated A or B under current recommendations of the U.S. Preventive Services Task Force.  This means that screenings for breast and colon cancer, diabetes, high blood pressure and high cholesterol will be covered, as well as tobacco cessation counseling. 
2. Routine immunizations for children, adolescents and adults recommended by the Advisory Committee on Immunization Practices.  This includes routine childhood vaccinations as well as periodic tetanus shots for adults.
3. Evidence-informed preventive care and screenings for infants, children and adolescents.  This includes regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations and obesity screening and counseling.
4. Evidence-informed preventive care and screenings for women.  HHS is expected to issue guidelines for this category of preventive care by August 1, 2010.

As new guidelines and recommendations for preventive care are developed, health plans and health insurance issuers will have to cover them without imposing cost-sharing requirements beginning with the plan year that is one year after the date of the publication of the guideline or recommendation.

The issuing agencies estimate that the effect of these rules will be to increase premiums by about 1.5% on average.