Tuesday, March 23, 2010

Employer Responsibilities Under Health Care Reform: Part 1

When President Barack Obama signs the Patient Protection and Affordable Care Act (H.R. 3590) today, health care reform becomes law, and some of provisions take effect quickly.

This is true with or without passage of the Health Care and Education Reconciliation Act of 2010 (H.R. 4872), which makes tax and revenue changes to H.R. 3590 (see yesterday’s post).

Within the next few weeks, Health Reform Talk will examine those proposals that will affects employer-provided plans in the near future. Today, preventive care is examined.

Preventive Care

Sec. 1001(5) of H.R. 3590 requires 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; and
  • additional women's preventive care and screenings "in comprehensive guidelines supported by the Health Resources and Services Administration."

Employer plans and insurers are required to comply with these preventive services mandates within six months of enactment (Sept. 23, 2010). These preventive care provisions are now included in Sec. 2713 of the Public Health Service Act

The bill includes a provision that excludes controversial November 2009 recommendations from the Preventive Services Task Force regarding breast cancer screening, mammography, and prevention. For these services, plans presumably will rely on previous recommendations.

For all other preventive services, employers will have to review the existing 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 cardiovascu-lar and diet-related chronic disease;
  • oral fluoride supplementation to preschool children older than six months of age;
  • screening for high blood pressure in adults aged 18 and older; and
  • screening and behavioral counseling interven-tions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.

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