Summaries based on the original text of the Patient Protection and Affordable Care Act (Passed by the US Senate 12-24-09. Passed by the US House of Representatives 3-21-10. Summary is for informational purposes only. Actual provisions and any amended portions of the bills apply).
Preventive Care Mandates
Group and individual plans must cover at a minimum and impose no cost sharing requirements for:
- “…evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force” (pp 20, lines 11-14).
- Immunizations that have a recommendation from the “Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention” (pp 20, lines 15 – 19).
- For infants, children and adolescents, “evidence informed preventive care and screenings” as stipulated in the “comprehensive guidelines” supported by the “Health Resources and Services Administration” (pp 20, lines 20-24).
- For women, additional preventive care and screenings as provided for and supported by the “Health Resources and Services Administration.” And for the Act and any other provision of law, the use the current recommendations of the “United States Preventive Service Task Force” regarding breast cancer screening, mammograms and prevention “shall be considered the most current other than those issued in or around November 2009.” (pp 21, lines 1-12).
- Nothing in the above referenced subsection of the Bill “shall be construed to prohibit” a health plan or insurer from providing coverage for preventive services over and above the services recommended by the “US Preventive Services Task Force.” Also, health plans or issuers are not prevented from denying services that exceed recommendations of the Preventive Services Task Force. (pp 21, lines 13-17).
This seems open the door to coverage for added screenings above and beyond those stipulated by the government. Also, it seems to acknowledge at least the possibility that such types of coverage may be permissible by law.
