by James A. Woehlke, Esq., CPA
General Counsel / COO, MBL Benefits Consulting Corp.
The Patient Protection and Affordable Care Act (the ACA*) was enacted on March 23, 2010. The ACA includes a requirement that preventive care specifically identified in regulations is to be provided at no cost to participants. Cost-sharing may be imposed on other preventive care. This is not a requirement imposed on grandfathered plans. The Administration issued guidance on this requirement in the form of interim final regulations on July 19, 2010.
The regulations define preventive care with reference to those recommendations from the
- United States Preventive Services Task Force which were believed to have the greatest beneficial effect (for evidenced-based items, those rated A or B).
- Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
- Health Resources and Services Administration
The current list of recommendations and guidelines required to be covered under the regulations is posted at www.healthcare.gov/center/regulations/prevention.html. (In the first category above, there are 45 procedures.) It is expected that these groups will augment their recommendations from time to time; and, health plans will need to expand (or decrease) coverage accordingly.
The regulations address what is to occur when preventive care is provided but not separately billed, if, for instance, a preventive care procedure is administered as part of a routine office visit, which otherwise requires a co-pay.
If you have questions about the new preventive care requirements, please contact your MBL Benefits consultant or the author at firstname.lastname@example.org.
* For simplicity, the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act are collectively referred to as the Affordable Care Act, or ACA.
Additional resources available at
Official publication of interim final regulations on preventive care coverage: http://federalregister.gov/a/2010-17242
From Proskauer Rose law firm, http://www.proskauer.com/publications/client-alert/health-care-reform-preventive-services-final-rules/.
From Venable LLP law firm, http://www.venable.com/files/Publication/cf848032-4911-4da3-b0e1-887f65921899/Presentation/PublicationAttachment/28f6dabc-8c97-4c04-9134-8d07c170586c/Preventive-Care-Coverage-Rules_8-30-10.pdf