The federal health care reform act (“PPACA”) passed last year directed the Obama administration to come up with a list of preventive services for women that all new health plans should cover without cost-sharing. This week, the medical advisory panel of the National Academy of Sciences’ Institute of Medicine made recommendations at the request of the Department of Health and Human Services. The guidelines are not binding, until decided upon by Kathleen Sebelius, the Secretary of the Department of Health and Human Services. She is expected to make a decision early next month.
The recommendations include barring co-payments on contraception approved by the FDA. For new mothers, a recommendation for comprehensive lactation support and counseling and cost of renting breastfeeding equipment was made. Also included are preventive screenings for pregnancy-related diabetes; HIV and human papillomavirus (HPV); screening for interpersonal and domestic violence; and multiple visits to obtain preventive services if they cannot be provided in one annual exam.
The administration estimates that 41 million Americans are in “new” employer or individual plans where the rules will apply. An additional 98 million people are covered by “grandfathered” policies exempt from the new rules. However, these plans can lose grandfathered status if they make changes to their coverage and payment policies. Based on that, it is estimated that by 2013, 47 million more Americans will be in employer plans covered by the new rules. The guidelines will also largely apply to plans covering federal employees, but not to Medicare, Medicaid or TriCare.
If approved, the mandates could go into effect in 2013.
Some of the news articles that I have read about the recommendations have generated a large number of reader comments, not surprisingly. One of the articles referred to this as being “free” coverage – what a misnomer! Many of the states already have mandates that cover some of these recommended preventive services already. These state mandates will preempt any federal guidelines if the mandates are broader than the federal guidelines.
I know that I will be watching to see what Kathleen Sebelius decides to do.
Editor’s recommendation: Keep current with mandated benefits with NILS INsource.
