PPACA: Agencies Release Preventive Care Regs

The new preventive services benefits mandate will apply to group plan years started on or after Sept. 23, 2010, and for individual policy years starting on or after that date, officials say.

The U.S. Preventive Services Task Force can put a service on the preventive services list by giving it a grade of A or B. The task force now assigns grades of A to services such as cholesterol screenings for men over 35 and women over 45, screenings for high blood pressure in adults ages 18 and older, and screenings for colorectal cancer in adults ages 50 to 75.

Services that receive B grades from the task force include routine cholesterol screenings for young adults, screening for diabetes in adults without symptoms who have high or moderately high blood pressure, and mammography for women ages 40 and older every 1 or 2 years.

If a preventive service "is billed separately (or is tracked as individual encounter data separately) from an office visit, then a plan or issuer may impose cost-sharing requirements with respect to the office visit," according to the text of the regulation.

If an individual goes to a doctor for a preventive service, such as a blood pressure check, and also gets some other kind of treatment, such as care for an earache, the plan can apply the usual cost-sharing rules to the care for the earache.

If a routine screening included in the mandate reveals health problems, the plan can apply its usual cost-sharing rules to efforts to treat the health problems.

"Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for [preventive services] that are delivered by an out-of-network provider," according to the regulation text.

Members of the public will have 60 days after the regulations are officially published in the Federal Register to submit comments.

The federal agencies involved decided to release the regulations as interim regulations, rather than completing a full public comment period first and developing a final rule, because of the rapidly approaching Sept. 23 compliance date imposed by Congress, officials say.