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PPACA: Expert Reviews Preventive Care List

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The new federal preventive care coverage implementation guidelines are “extremely specific and comprehensive.”

Mark Stember, a partner at Kilpatrick Stockton L.L.P., Washington, gives that assessment in an analysis posted by the Employers Council on Flexible Compensation, Washington.

The preventive care regulations were released earlier this week by arms of the U.S. Treasury, Labor and Health and Human Services departments.

The regulations describe the preventive care services ordinary “non-grandfathered” group health plans and individual health insurance policies must cover to implement the new preventive care requirements in the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

In addition to procedures such as blood pressure checks, mammograms and colon cancer screenings, plans now must cover services such as obesity screening, smoking cessation counseling and well-child visits without applying co-payment, deductible or coinsurance cost-sharing requirements for those services.

If a group plan or health insurer bills for the office visit and the preventive care services separately, it can apply the usual cost-sharing rules to the underlying office visit.

The rules apply to non-grandfathered plans starting with the first plan or policy year that begins on or after Sept. 23.

The guidelines “go well beyond what the typical employer-sponsored group health plan currently considers to be preventive care,” Stember writes.

Counseling for alcohol misuse, tobacco misuse and weight management advice are in the new preventive care requirements but are not necessarily classified as preventive care services under current health plan rules, Stember says.


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