August 2010
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For more information, contact:
Kim Houlton, SPHR
Director of Human Resources
920-996-1328 |
A major component of The Patient Protection and Affordable Care Act (PPACA) addresses the coverage of preventive care services. On July 19, 2010, preventive care regulations were published in the Federal Register.
When your plan will be affected…
On the first day of the first plan year following September 23, 2010, insurance plans (including individual, fully insured and self-funded plans) must provide the required coverage for preventive care services. Plans that maintain grandfathered status will be exempt from these rules.
What must be covered…
Specified preventive services for children and adults must be covered without the imposition of cost-sharing measures such as deductibles, co-pays or coinsurance. This is also referred to as “first-dollar coverage.” In effect, a benefit of 100% paid preventive care is provided when those services are performed by an in-network provider.
For Children
- Alcohol and drug assessments for adolescents
- Autism screening at 18 and 24 months
- Behavioral Assessments
- Cervical Dysplasia screening for sexually active females
- Congenital Hypothyroidism screening for newborns
- Depression screening for adolescents
- Developmental screening for children under age 3
- Dislipidemia screening for high risk children
- Fluoride chemoprevention supplements
- Gonorrhea preventive medication for the eyes of newborns
- Hearing screening for newborns
- Height, weight and body mass index
- Hematocrit or Hemoglobin screening
- Hemoglobinopathies (sickle cell) screening for newborns
- HIV screening for high risk adolescents
- Immunizations at specified ages
- Iron supplements for high risk infants
- Lead screening for high risk children
- Medical history
- Obesity screening and counseling
- Oral health assessment
- Phenylketonuria (PKU) screening for newborns
- Sexually Transmitted Infection prevention counseling for high risk adolescents
- Tuberculin testing for high risk children
- Vision screening
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For Adults
- Abdominal Arotic Aneurysm screening (once) for men ages 65-75 who have ever smoked
- Alcohol misuse screening and counseling
- Anemia screening for pregnant women
- Aspirin use
- Bacteruria urinary tract or other infection screening for pregnant women
- Blood Pressure screening
- BRCA counseling for genetic testing for higher risk women
- Breast Cancer chemoprevention for higher risk women
- Cervical cancer screening for sexually active women
- Chlamydia infection screening for higher risk women
- Cholesterol screening for higher risk individuals
- Colorectal cancer screening after age 50
- Depression screening
- Type 2 Diabetes screening
- Diet counseling for higher risk individuals
- Folic acid supplements for women who may become pregnant
- Gonorrhea screening for higher risk women
- Hepatitis B screening for pregnant women
- HIV screening for higher risk individuals
- Immunizations
- Interventions to support breast feeding for women
- Mammography screenings for women every 1-2 years after age 40
- Obesity screening and counseling
- Osteoporosis screening for women over age 60
- Rh incompatibility screening for pregnant women
- Sexually Transmitted Infection prevention counseling for higher risk individuals
- Tobacco use screening and cessation interventions
- Syphilis screening for higher risk individuals
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What your business should do…
If you provide health insurance to your employees, consider the additional costs your plan will incur by providing the required preventive care services. Determine whether or not you will maintain grandfathered status and thereby avoid the preventive care mandates. If you will not maintain grandfathered status, be sure your plan is in compliance with the new rules and that your summary plan description (SPD) is amended accordingly.
Preventive Care Services Fact Sheet
http://www.healthcare.gov/law/about/provisions/services/index.html
Published Preventive Care Regulations
http://www.healthcare.gov/center/regulations/prevention/regs.html
July 19, 2010 Federal Register
http://69.175.53.6/register/2010/jul/19/2010-17242.pdf
New Health Care Resource
Healthcare.gov is a new website managed by the US Department of Health & Human Services. For the latest information and regulations regarding Preventive Care Services as well as other provisions of Health Care Reform, visit http://www.healthcare.gov/. |
Kim Houlton has extensive experience in the management of human capital and human resources strategies in multiple industries. Her responsibilities at Schenck include the execution of human resources strategy, talent management, compensation and benefits, training and development, regulatory compliance, employee services, and human resources consulting with clients. Her background also includes overseeing policies and procedures for companies with multi-state operations and rapidly growing and changing work environments.
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