Friday, December 4, 2009

Employers Need To Be Prepared For Preventive Services Mandates In Health Reform

After four days of generalized sniping at each other, the full Senate began yesterday to vote on the scores of amendments already filed for the Patient Protection and Affordable Care Act, H.R. 3590.

A preventive services expansion and a Medicare benefits guarantee were the first amendments agreed to by the Senate.  The Medicare benefits guarantee is a feel good measure that passed 100-0 and simply confirms that health reforms will not reduce guaranteed Medicare benefits and that Medicare savings will be used to extend the solvency of the Medicare program.

The preventive services expansion, on the other hand, reinforces the potential changes employer group health plans will need to make quickly if health reform passes.

Sen. Barbara Mikulski (Md.) proposed the amendment that would expand the legislation’s first dollar coverage of preventive health services to include additional women’s preventive care and screenings “in comprehensive guidelines supported by the Health Resources and Services Administration.”

The bill already would require group health plans to cover, with no cost sharing, the following:
  • certain evidence-based items (with A or B ratings) in the recommendations of the United States Preventive Services Task Force;

  • immunizations  recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention

  • evidence-based preventive care and screenings for infants, children, and adolescents provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

The Mikulski amendment, which passed the Senate by a vote of 61-39, includes a provision from by Sen. David Vitter (La.) that would exclude controversial November 2009 recommendations from the Preventive Services Task Force regarding breast cancer screening, mammography, and prevention.

One of the most important provisions is that employers would be required to comply with these preventive services mandates within six months of enactment of H.R. 3590.

This means that employers will have to review the previous recommendations of the Task Force and be prepared to offer a variety of preventive care with no cost sharing permitted.  Here are just a few of the recommended services with the required A or B ratings which employers would have to offer and provide with no deductibles or coinsurance:
  • screening adults for depression;

  • intensive behavioral dietary counseling for adult patients with known risk factors for cardiovascular and diet-related chronic disease;

  • oral fluoride supplementation to preschool children older than 6 months of age;

  • screening for high blood pressure in adults aged 18 and older;

  • screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.


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