The Departments of Health and Human Services (HHS), Labor, and the Treasury issued new regulations today, requiring new private health plans to cover evidence-based preventive services and eliminate cost sharing requirements for such services. The new rules will help Americans gain easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children.
"Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs," said HHS Secretary Sebelius. "From the Recovery Act to the First Lady's Let's Move Campaign to the Affordable Care Act, the Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy."
Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation's health spending - and often are preventable. Nationally, Americans use preventive services at about half the recommended rate. An estimated 11 million children and 59 million adults have private insurance that does not adequately cover immunization, for instance. Cost sharing, including deductibles, coinsurance, or copayments, has been found to reduce the likelihood that preventive services will be used.
"Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure," said First Lady Michelle Obama. "And good preventative care will also help tackle an issue that is particularly important to me as First Lady and as a mother - and that is the epidemic of childhood obesity in America today. These are important tools, and now it's up to us to use them."
"One of the best ways to improve the quality of your life - and control health care costs - is to prevent illness in the first place," said Dr. Jill Biden. "Focusing on prevention and early treatment makes more sense than trying to play catch-up with a potentially deadly disease. Quite simply, these preventative services will save lives."
Under the regulations issued today, new health plans beginning on or after September 23, 2010, must cover preventive services that have strong scientific evidence of their health benefits, and these plans may no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider. Specifically, these recommendations include:
* Evidence-based preventive services: The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a "grade" of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.
* Routine vaccines: Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices ranging from routine childhood immunizations to periodic tetanus shots for adults.
* Prevention for children: Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These guidelines provide pediatricians and other health care professionals with recommendations on the services they should provide to children from birth to age 21 to keep them healthy and improve their chances of becoming healthy adults. The types of services that will be covered include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.
* Prevention for women: Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by August 1, 2011.
Today's announcement builds on other provisions in the Affordable Care Act that support prevention, including the creation of a first-ever National Prevention, Health Promotion and public Health Council tasked with developing a national strategy and a Prevention and Public Health Fund to invest in prevention initiatives and, this year, policies to increase the number of primary care professionals to help ensure access to these services. The Affordable Care Act also helps make it easier and more affordable for Americans enrolled in Medicare or Medicaid to access critical preventive screenings and services.
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Showing posts with label preventive. Show all posts
Showing posts with label preventive. Show all posts
Wednesday, July 14, 2010
Monday, July 05, 2010
Statement from Secretary Sebelius on Proposed CMS Rule to Expand Medicare Preventive Services and Expand Access to Primary Care
On June 25, the Centers for Medicare & Medicaid Services (CMS) took another important step to help improve the health status of Medicare beneficiaries. The proposed regulation will implement the new preventive health benefits created under the Affordable Care Act for the seniors and persons with disabilities who rely on Medicare for their health care coverage.
The new rule proposes to make two significant improvements to preventive care benefits under Medicare: Beginning January 1, 2011, Medicare will cover annual wellness visits so that doctors and patients can develop a personalized prevention plan that takes a comprehensive approach to improving the patient’s health. Also beginning January 1, 2011, Medicare beneficiaries will no longer have to pay any out-of-pocket costs for most preventive services – including that annual wellness visit.
To help make sure that Medicare beneficiaries have access to primary care doctors, the rule would also boost payments for primary care services. The proposed regulation would also increase access to services by creating payment incentives for general surgeons as well as expand access to other types of health care providers.
Improving access to preventive services and primary care is a top priority for HHS. The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries – and all Americans. We recently announced the allocation of $500 million from the Prevention and Public Health Fund – created by the Affordable Care Act – to invest in the training and development of primary care professionals as well as preventive care activities and public health infrastructure.
With these new benefits under Medicare, and investments in our health care system, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease.
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The new rule proposes to make two significant improvements to preventive care benefits under Medicare: Beginning January 1, 2011, Medicare will cover annual wellness visits so that doctors and patients can develop a personalized prevention plan that takes a comprehensive approach to improving the patient’s health. Also beginning January 1, 2011, Medicare beneficiaries will no longer have to pay any out-of-pocket costs for most preventive services – including that annual wellness visit.
To help make sure that Medicare beneficiaries have access to primary care doctors, the rule would also boost payments for primary care services. The proposed regulation would also increase access to services by creating payment incentives for general surgeons as well as expand access to other types of health care providers.
Improving access to preventive services and primary care is a top priority for HHS. The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries – and all Americans. We recently announced the allocation of $500 million from the Prevention and Public Health Fund – created by the Affordable Care Act – to invest in the training and development of primary care professionals as well as preventive care activities and public health infrastructure.
With these new benefits under Medicare, and investments in our health care system, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease.
-----
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Wednesday, September 23, 2009
Vice President Biden, Secretary Sebelius Issue New Report on Seniors and Health Insurance Reform
Vice President Joe Biden and Health and Human Services (HHS) Secretary Kathleen Sebelius today hosted a town hall meeting with seniors in Silver Spring, Md., and released a new report,
Health Insurance Reform and Medicare: Making Medicare Stronger for America's Seniors. The report, authored by HHS, outlines how health insurance reform will help seniors and answers key questions about President Obama's health insurance reform plan. The complete report is
available now at www.HealthReform.gov.
"We will protect seniors -- not burden them with out of pocket costs," said Vice President Biden. "The bottom line is, seniors will be better off under what we are proposing, and not a dollar from the Medicare trust fund will be used to pay for health insurance reform."
"Under health insurance reform, seniors will get better care and their health care costs will go down," said Secretary Sebelius. "Reform will strengthen Medicare, cut drug costs, and help ensure all seniors get the high-quality, affordable care they deserve."
The report highlights several problems in the current health care system and health insurance reform solutions such as:
* Preserving and strengthening Medicare.
According to the Medicare Trustees 2009 report, the Medicare Part A
Trust Fund will be exhausted by 2017. Health insurance reform will
extend the life of the Medicare Trust Fund by an additional four to five
years -- and delivery system reforms included in health insurance reform
have the potential to keep the Trust Fund solvent even longer into the
future. Health insurance reform will also reduce overpayments to private
plans and will clamp down on fraud and abuse to strengthen Medicare for
all seniors. Coupled with improvements in the quality of care, expansion
of the health care workforce, and reductions in out-of-pocket costs,
health insurance reform will ensure that Medicare will continue to
provide the high-quality, affordable coverage that America's seniors
deserve and expect.
* Cutting high prescription drug costs.
Prescription drug costs represent a significant expense for seniors.
While Medicare added a prescription drug benefit, this benefit includes
a coverage gap commonly called the "donut hole." In 2007, over 8 million
seniors hit the "donut hole." For those who are not low-income or have
not purchased other coverage, average drug costs in this coverage gap
are $340 per month, or $4,080 per year. Health insurance reform will
close the coverage gap in Medicare Part D over time, so seniors do not
have to worry about losing coverage for their drug costs. While the
closure of the coverage gap is phased in, health insurance reform will
also provide seniors with a discount of 50 percent on their brand name
medication costs in the coverage gap, saving thousands of dollars for
some seniors.
* Making preventive services free.
Many seniors do not receive recommended preventive and primary care,
leading to less effective and more expensive treatments. For example, 20
percent of women aged 50 and over did not receive a mammogram in the
past two years, and 38 percent of adults aged 50 and over have never had
a colonoscopy or sigmoidoscopy. Seniors in Medicare must pay 20 percent
of the cost of many preventive services on their own. For a colonoscopy
that costs $700, this means that a senior must pay $140 -- a price that
can be prohibitively expensive. Under health insurance reform, a senior
would not pay anything for a screening colonoscopy or other preventive
services. Reform will eliminate any deductibles, copayments, or other
cost-sharing for obtaining preventive services, making them affordable
and accessible.
* Ending overpayments to private insurance companies that cost all
Medicare beneficiaries.
The federal government pays private insurance companies on average 14
percent more for providing coverage to Medicare Advantage beneficiaries
than it would pay for the same beneficiary in the traditional Medicare
program. There is no evidence that this extra payment leads to better
quality for Medicare beneficiaries, and all Medicare beneficiaries pay
the price of these excessive overpayments through higher premiums --
even the 78 percent of seniors who are not enrolled in a Medicare
Advantage plan. A typical couple in traditional Medicare will pay on
average nearly $90 next year to subsidize private insurance companies
that do not provide their Medicare benefits. Health insurance reform
will eliminate excessive government subsidies to Medicare Advantage
plans, which could save the federal government, taxpayers, and Medicare
beneficiaries well over $100 billion over the next 10 years.
-----
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www.georgiafrontpage.com
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Health Insurance Reform and Medicare: Making Medicare Stronger for America's Seniors. The report, authored by HHS, outlines how health insurance reform will help seniors and answers key questions about President Obama's health insurance reform plan. The complete report is
available now at www.HealthReform.gov.
"We will protect seniors -- not burden them with out of pocket costs," said Vice President Biden. "The bottom line is, seniors will be better off under what we are proposing, and not a dollar from the Medicare trust fund will be used to pay for health insurance reform."
"Under health insurance reform, seniors will get better care and their health care costs will go down," said Secretary Sebelius. "Reform will strengthen Medicare, cut drug costs, and help ensure all seniors get the high-quality, affordable care they deserve."
The report highlights several problems in the current health care system and health insurance reform solutions such as:
* Preserving and strengthening Medicare.
According to the Medicare Trustees 2009 report, the Medicare Part A
Trust Fund will be exhausted by 2017. Health insurance reform will
extend the life of the Medicare Trust Fund by an additional four to five
years -- and delivery system reforms included in health insurance reform
have the potential to keep the Trust Fund solvent even longer into the
future. Health insurance reform will also reduce overpayments to private
plans and will clamp down on fraud and abuse to strengthen Medicare for
all seniors. Coupled with improvements in the quality of care, expansion
of the health care workforce, and reductions in out-of-pocket costs,
health insurance reform will ensure that Medicare will continue to
provide the high-quality, affordable coverage that America's seniors
deserve and expect.
* Cutting high prescription drug costs.
Prescription drug costs represent a significant expense for seniors.
While Medicare added a prescription drug benefit, this benefit includes
a coverage gap commonly called the "donut hole." In 2007, over 8 million
seniors hit the "donut hole." For those who are not low-income or have
not purchased other coverage, average drug costs in this coverage gap
are $340 per month, or $4,080 per year. Health insurance reform will
close the coverage gap in Medicare Part D over time, so seniors do not
have to worry about losing coverage for their drug costs. While the
closure of the coverage gap is phased in, health insurance reform will
also provide seniors with a discount of 50 percent on their brand name
medication costs in the coverage gap, saving thousands of dollars for
some seniors.
* Making preventive services free.
Many seniors do not receive recommended preventive and primary care,
leading to less effective and more expensive treatments. For example, 20
percent of women aged 50 and over did not receive a mammogram in the
past two years, and 38 percent of adults aged 50 and over have never had
a colonoscopy or sigmoidoscopy. Seniors in Medicare must pay 20 percent
of the cost of many preventive services on their own. For a colonoscopy
that costs $700, this means that a senior must pay $140 -- a price that
can be prohibitively expensive. Under health insurance reform, a senior
would not pay anything for a screening colonoscopy or other preventive
services. Reform will eliminate any deductibles, copayments, or other
cost-sharing for obtaining preventive services, making them affordable
and accessible.
* Ending overpayments to private insurance companies that cost all
Medicare beneficiaries.
The federal government pays private insurance companies on average 14
percent more for providing coverage to Medicare Advantage beneficiaries
than it would pay for the same beneficiary in the traditional Medicare
program. There is no evidence that this extra payment leads to better
quality for Medicare beneficiaries, and all Medicare beneficiaries pay
the price of these excessive overpayments through higher premiums --
even the 78 percent of seniors who are not enrolled in a Medicare
Advantage plan. A typical couple in traditional Medicare will pay on
average nearly $90 next year to subsidize private insurance companies
that do not provide their Medicare benefits. Health insurance reform
will eliminate excessive government subsidies to Medicare Advantage
plans, which could save the federal government, taxpayers, and Medicare
beneficiaries well over $100 billion over the next 10 years.
-----
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www.georgiafrontpage.com
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