Preventive Services Mandate Outlined A new fact sheet from the Kaiser Family Foundation outlines prevention requirements under the Affordable Care Act (ACA)—including screenings for conditions related to communication disorders—and discusses the possible economic impact of the requirements. Under the ACA, private health plans—other than those in existence prior to March 23, 2010, and thus ... Policy Analysis
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Policy Analysis  |   October 01, 2011
Preventive Services Mandate Outlined
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   October 01, 2011
Preventive Services Mandate Outlined
The ASHA Leader, October 2011, Vol. 16, 3. doi:10.1044/leader.PA2.16122011.3
The ASHA Leader, October 2011, Vol. 16, 3. doi:10.1044/leader.PA2.16122011.3
A new fact sheet from the Kaiser Family Foundation outlines prevention requirements under the Affordable Care Act (ACA)—including screenings for conditions related to communication disorders—and discusses the possible economic impact of the requirements.
Under the ACA, private health plans—other than those in existence prior to March 23, 2010, and thus exempt from new regulations—must provide coverage for a range of preventive services and may not charge any copayments, deductibles, or co-insurance to patients receiving these services. The majority of the preventive care requirements went into effect on Sept. 23, 2010; women’s preventive care services take effect Aug. 1, 2012. Exempt plans, however, relinquish that status if they make significant changes to their coverage (e.g., increasing patient cost-sharing, cutting benefits, or reducing employer contributions).
With preventive care, according to the foundation, health problems may be identified earlier, managed more effectively, and treated before they develop into more complicated or debilitating illness. Co-payments and deductibles can act as a barrier to use of preventive services; the ACA specifically prohibits such out-of-pocket costs for the preventive services, with some exceptions (office visit and preventive services are billed separately; primary reason for the visit is not the preventive screening; service is performed by an out-of-network provider).
The ACA provides specifically for children’s preventive health needs, requiring private insurers to cover—without cost-sharing—the preventive services recommended by the Health Resources and Services Administration. Covered preventive services for children and adolescents include routine immunizations for several diseases; screening for a number of conditions and diseases, including hearing and autism; and behavioral and developmental assessments.
Impact
Some plans already cover many preventive services and several states mandate their coverage, resulting in different effects on premium costs. In general, increased use of some preventive services could improve worker productivity and prevent the development of costly illness, thereby possibly reducing premium costs; conversely, increased use of some preventive services not fully offset by future savings may result in higher premiums.
For more information, visit the Kaiser Family Foundation website.
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October 2011
Volume 16, Issue 12