New Reg Aims to Make Preventive Health Services More Accessible, Affordable – Say Ahhh! A Children’s Health Policy Blog

“An ounce of prevention is worth a pound of cure.”

It is not often that I find myself quoting Benjamin Franklin, but it seems particularly apropos this week with the release of the latest Affordable Care Act regulation. On Wednesday, the Obama administration issued new rules requiring that health plans provide a series of expert-recommended preventive services without co-payments or deductibles.  This is particularly good news for children since included in the mix of required services are those recommended by Bright Futures, the American Academy of Pediatric’s “gold standard” of care for children, and immunizations recommended by the CDC. This includes: 

  • Well-baby and well-child doctor visits covering an array of services including physical exams, vision and hearing screenings, oral health risk assessments, and developmental assessments.
  • Screenings and counseling to prevent, detect, and treat common childhood problems like obesity, depression, dental cavities, and anemia.
  • Immunizations like an annual flu vaccines, and many other childhood vaccinations and boosters.

Research continues to show that significant long-term health benefits (in addition to decreased health costs and increased worker productivity) can be derived from the utilization of preventive services. Unfortunately, even with the long ago wisdom of Benjamin Franklin, Americans continue to fall behind in receiving this care. For example, according to research conducted by the Commonwealth Fund, about one-third of young children do not receive an adequate level of basic preventive and developmental services. 

The new rules are meant to change this dynamic by making preventive services more readily available and affordable. The Administration estimates that 31 million people in employer-sponsored plans and 10 million people in individual plans will receive these new benefits in the next year. However, it is important to note that the rules apply only to new health plans (that begin coverage after Sept. 23, 2010), not to those that have grandfather status.  

In addition to children’s services, all non-grandfathered health plans will be required to provide with no cost sharing (the full lists are available at  

  • Tests and screening recommended by the United States Preventive Services Task Force. This includes blood pressure, prenatal care, diabetes and cholesterol tests, screenings for cancer, HIV, obesity, and depression, and smoking cessation counseling.
  •  Immunizations for adults recommended by the CDC.
  •  Preventive care and screenings for women (not otherwise addressed) recommended by HRSA. (These guidelines are currently being developed and will be released next year.)

The rules also provide some clarification on what charges can be applied when doctors combine billing for a preventive service with an office visit: short answer, insurers cannot apply cost-sharing for the doctor visit if the recommended-preventive service was the sole purpose of that visit. Plans also are not obligated to cover services or waive cost sharing if provided out of network. The Administration estimates that premiums will increase on average about 1.5 percent as a result of these changes. 

The new requirements provide significant new benefits for consumers, and now the work begins to ensure that individuals and families can (through monitoring and enforcement of the rules) and do (through public education) access the preventive services that Ben so wanted us to have.

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