Under new rules announced by the White House on Wednesday, new private health plans will be required to cover preventive services—and eliminate most cost-sharing requirements—for such procedures as blood pressure, diabetes and cholesterol tests, many cancer screenings, routine vaccinations, prenatal care, and regular wellness visits for infants and children.
The new regulations, issued by the departments of Health & Human Services, Labor, and the Treasury, will be put into place on Sept. 23, 2010. New health plans beginning on or after that date must cover evidence-based preventive services that demonstrate strong health benefits. These plans may no longer charge a patient a copayment, coinsurance, or deductible for these services when they are delivered by a network provider.
"We've got a long way to go, but already you can see a more friendly health insurance market taking place," said HHS Secretary Kathleen Sebelius, speaking at a briefing at George Washington University Medical Center. "But we knew we had to make it easier for Americans whether they had health insurance or not to get screenings, go to doctor visits, get vaccines, and keep them out of the emergency rooms and hospital beds."
"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 at the briefing. And good preventative care will also help tackle an issue that is particularly important to me as First Lady ... childhood obesity in America today. These are important tools, and now it’s up to us to use them."
Under the new regulations, "evidence based preventive services" refer to the services rated by the U.S. Preventive Services Task Force, an independent panel of scientific experts. These services are rated by the group based on the strength of the scientific evidence documenting their benefits.
Preventive services with a grade of A or B, such as breast or 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.
Among the areas addressed in the regulation:
- Health plans will cover a set of standard set of vaccines recommended by the Advisory Committee on Immunization Practices—ranging from routine childhood immunizations to periodic tetanus shots for adults.
- 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.
The guidelines provide pediatricians and other healthcare 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.
Among the services covered are regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight. - 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.
One area that will not be covered under the new provision is abortions, the HHS press office clarified Wednesday evening. As is the case with Federal Employees Health Benefit plans and the current healthcare reform law, abortions will not be covered as a pre existing condition for insurance plans except in the cases of rape or incest, or where the life of the woman would be endangered.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.