On July 14, 2010, the Departments of Treasury, Labor and Health and Human Services (the Departments) issued interim final regulations on preventive health services under the Patient Protection and Affordable Care Act, as amended. The new rules generally apply to group health plans and group health insurance issuers offering group and individual health insurance coverage for plan years beginning on or after September 23, 2010.
With the goal of making evidence-based health services readily available, the new regulations preclude non-grandfathered plans from imposing cost-sharing requirements, such as co-pays and deductibles, on the following types of recommended preventive health services:
- Evidence-based services or items that have in effect a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force with respect to the individual involved. The regulations note “preventive services given a grade of A or B by the Task Force have been determined by the Task Force to have at least fair or good evidence that the preventive service improves important health outcomes and that benefits outweigh harms in the judgment of an independent panel of private sector experts in primary care and prevention.”
- Immunizations for routine use in children, adolescents and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved. The mission of the Advisory Committee is to provide advice that will lead to a reduction in the incidence of vaccine-preventable diseases in the United States and an increase in the safe use of vaccines and related biological products.
- With respect to infants, children and adolescents, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) (not otherwise addressed by the recommendations of the Task Force).
- With respect to women, evidenceinformed preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of the Task Force). The Department of Health and Human Services is developing these guidelines and expects to issue them no later than August 1, 2011. It should be noted that nothing in the regulations prohibits plans or issuers from imposing cost-sharing requirements for preventive services not recommended in these rules.
With these new rules, the Departments anticipate that: (1) individuals will experience improved health; (2) healthier workers and children will be more productive; (3) the preventive services will result in savings due to lower health care costs; and (4) the cost of preventive services will be distributed more equitably.