HHS Issues Regulations for Preventive Benefits

Rules set to go into effect this fall mandate coverage of mammograms and more.

ByABC News
July 16, 2010, 6:08 PM

WASHINGTON, July 18, 2010— -- Private insurers will be required to cover certain preventive benefits -- such as mammograms and colonoscopies -- without requiring patients to pay deductibles or copays, according to rules issued today by the Department of Health and Human Services (HHS).

The interim final regulations, which take effect on Sept. 23, require private health plans to cover all preventive services given an "A" or "B" recommendation by the U.S. Preventive Services Task Force, as well as preventive services recommended by the Advisory Committee on Immunization Practices.

The covered services include screening for abdominal aortic aneurysm, aspirin to prevent cardiovascular disease, alcoholism and smoking cessation counseling, immunizations, screening mammograms and colonoscopies, and screening for other chronic conditions including hypertension, hypercholesterolemia, hepatitis, diabetes, HIV, osteoporosis, and iron deficiency. They also include screening for obesity as well as weight-loss counseling.

"We know chronic diseases are often preventable," HHS Secretary Kathleen Sebelius said in a teleconference announcing the new rules. "But one of biggest [barriers] is cost. Even families with insurance can be out of [money for the] copay to pay for these critical care items."

Obama Administration officials acknowledged that implementing the new rules will result in an average 1.5 percent increase in premium increases to pay for the services being added. But, said Jeanne Lambrew, director of the HHS Office of Health Reform, "much of that is a shift, since people were already paying for these services out of their deductible."

And for some people at high risk of chronic disease, receiving these free preventive services "will actually be a savings," she added.

Although estimates of the number of people affected by the new rules vary, a "mid-range" estimate from HHS suggests the rules will affect roughly 31 million people this year, growing to approximately 78 million in 2013. The rules do not apply to "grandfathered" health plans that patients were enrolled in on March 23, 2010 -- the day the Affordable Care Act was signed into law -- but HHS officials says they expect the number of grandfathered plans to decrease over time.