Preventive care takes the spotlight

Have you ever heard of the U.S. Preventive Services Task Force? If you’re like most people, you probably haven’t, though some of you might recall the brouhaha over the Task Force’s mammography recommendations last fall. However, members of this once obscure agency founded in 1984 are likely to find themselves the target of some serious lobbying as advocates push to have their top priorities considered covered services under Task Force guidelines. In fact, one commentator suggests that the Task Force “could become a political lightning rod” as insurers might not pay for a service that don't receive the backing of the Task Force.

 

So what? Why does this Task Force matter? You see, under health reform, health plans and issuers will be required to provide coverage, without cost-sharing, for certain preventive services. This provision applies to, among other things, evidence-based items or services that are currently recommended by the U.S. Preventive Services Task Force. Now, a trio of government agencies has issued regulations (to be published on July 19th) that clarify what this provision means.

 

Under these new rules, evidence-based items or services that have in effect a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force with regard to the individual involved would have to be covered without cost-sharing requirements. Currently, the list of services with a rating of A or B is long but includes such things as:

 

1. screening and counseling to reduce alcohol misuse;
2. aspirin therapy for certain men age 45-79 years and women age 55 to 79 years;
3. assorted pregnancy-care screenings; and
4. screenings for depression, cholesterol abnormalities, anemia, hypothyroidism, obesity, colorectal cancer, tobacco use, and visual acuity in children.

 

The new rules also indicate that Task Force recommendations for mammography screening that were issued in 2009 which recommended routine screening for women age 50 and older, will not be considered current. Instead, those issued in 2002, which recommended earlier screening starting at age 40, will be used.

 

Beyond that, the new regulations clarify the cost-sharing requirements for recommended preventive services provided during office visits. For example, if a recommended preventive service (RPS) is billed separately from an office visit, then cost-sharing requirements for the office visit may be imposed. If an RPS is not billed separately and the primary purpose of the visit is the delivery of a preventive item or service, then cost-sharing requirements may not be imposed. If an RPS is not billed separately but the primary purpose of the office visit is not the delivery of a preventive item or service, then cost-sharing requirements may be imposed.

 

As with other issues arising out of health reform, stay tuned for developments. This is an area that is sure to be ever-evolving.

 

For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.