July 23, 2010

HHS Releases Regulations on Preventive Care

The Departments of Health and Human Services, Labor, and the Treasury issued new regulations as part of The Affordable Care Act, that require private health plans to cover evidence-based preventive services and to eliminate cost-sharing for preventive care.  This means that for new health policies beginning on or after September 23, 2010, preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge its members a copayment, coinsurance or deductible for these services.  

Depending on your age and health plan type, members may have easier access to preventive services such as:  

  • Blood pressure, diabetes and cholesterol tests
  • Many cancer screenings
  • Counseling from healthcare providers on such topics as quitting smoking, losing weight, eating better, treating depression and reducing alcohol use
  • Routine vaccines for diseases such as measles, polio or meningitis
  • Flu and pneumonia shots
  • Counseling, screening and vaccines for healthy pregnancies
  • Regular well-baby and well-child visits, from birth to age 21

The new regulation ensures that a comprehensive set of preventive services is available in new health plans with no cost-sharing for the following:

Children’s Health Services

  • Well-baby and well-child visits: This includes a doctor’s visit every few months when your baby is young, and a visit every year until your child is age 21. These visits will cover  preventive health services such as physical exam and measurements; vision and hearing screenings; oral health risk assessments; developmental assessments to identify any development problems; screenings for hemoglobin level, lead, tuberculin and other tests.
  • Screenings and counseling to prevent, detect, and treat common childhood problems such as obesity, depression among adolescent children and dental cavities and anemia
  • Immunizations such as an annual flu vaccine and many other childhood vaccinations and boosters, from the measles to polio

Pre-Natal Care

  • Screening for conditions that can harm pregnant women or their babies, including iron deficiency, hepatitis B, a pregnancy-related immune condition called Rh incompatibility, and a bacterial infection called bacteriuria
  • Special, pregnancy-tailored counseling from a doctor that will help pregnant women quit smoking and avoid alcohol use
  • Counseling to support breast-feeding and help nursing mothers

Heart Disease and Obesity Care

  • Screening for obesity and counseling from your doctor and other health professionals to promote sustained weight loss, including dietary counseling
  • Blood pressure screening
  • Counseling on the use of daily aspirin to reduce the risk of a stroke
  • Tests to screen for high cholesterol and diabetes

Cancer Screening and Services

  • Preventing breast cancer: Annual mammograms for women over 40. Other services to prevent breast cancer will also be covered, including a referral to genetic counseling and a discussion of chemoprevention for certain women at increased risk.
  • Preventing cervical cancer: Regular Pap smears to screen for cervical cancer and coverage for the HPV vaccine that can prevent cases of cervical cancer
  • Tobacco cessation interventions, such as counseling or medication to help individuals quit
  • Preventing colon cancer: Screening tests for colon cancer for adults over 50

Learn more about the covered services

The information on this website is based on BCBSLA’s review of the national healthcare reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.