On July 14, 2010 the Department of Health and Human Services, the Department of the Treasury, and the Department of Labor announced new regulations of the Affordable Care Act. The rules address preventive care services for individuals or families enrolling in new private health plans beginning on or after September 23, 2010. Often because of cost, Americans use preventive services at about half the recommended rate. Even for people with health insurance, preventive care is often set aside because of the extra cost of paying out-of-pocket for services not covered by their individual health plans. Therefore, patients may present for healthcare in the advanced stages of a preventable disease. Covered individuals will now be able to receive evidence-based preventive services without additional cost-sharing beyond the usual premiums. New health plans must cover specified preventive services and will no longer require a copayment, coinsurance, or deductible from the patient as long as the patient uses a provider in the network.
In support of prevention
The Affordable Care Act generally supports wellness and prevention. Included in preventive services are screenings, routine vaccines, and special services for children and women. Health plans will look to independent groups to determine which services fall within the limits of the new rule. Several groups have been mentioned, such as the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Bright Futures guidelines (from the Health Resources and Services Administration and the American Academy of Pediatrics). The new rule will hopefully help reduce health disparities and allow African Americans, Latinos, seniors, and other disadvantaged populations who are disproportionately affected by many chronic conditions to benefit from preventive care.
An earlier set of rules, which are to be finalized on or before November 1, 2010 will implement no beneficiary out-of-pockets costs for most preventive care and coverage for an annual wellness visit at no expense to beneficiaries for individuals insured by Medicare beginning in 2011. States that offer evidence-based prevention services will receive additional federal Medicaid matching funds.
Stepping into the light
These rules are welcome news for NPs, especially those working in primary care. Limited or no access to preventive services has been a major deterrent in helping patients obtain optimal health. Primary care providers are often working in the dark. Patients do not consent to or participate in recommended preventive services and clinicians are not able to develop evidence-based management strategies because of missing information or denied opportunities. Being able to access services such as blood pressure, diabetes, and cholesterol tests; cancer screenings; counseling for smoking cessation, nutrition, depression, and substance abuse; routine vaccines; prenatal care; and well-baby and well-child visits from birth to 21 years will change the lives of many people and improve their overall health by helping to prevent the onset or progression of chronic diseases that contribute to the population's morbidity and mortality.
A look ahead
The expected outcomes of preventive services are improved health, greater workforce productivity, and reduced healthcare costs. For the providers 'on the ground running', these new regulations will translate into reasonable reimbursement for services, and for NPs' equity too. The many changes in the nation's healthcare delivery system are motivating and challenging at the same time. We simply must continue to 'change with the times', making sure we remain 'front and center';.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
Editor-in-Chief [email protected]
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