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Interim Final Regulations for Coverage of Preventive Services Under Health Care Reform Released

    Client Alerts
  • July 16, 2010

On July 14, 2010, the Departments of Labor, Health and Human Services and Treasury jointly released interim final regulations (the "Interim Rule") implementing the rules for group health plans regarding preventive health services under the Patient Protection and Affordable Care Act, as amended ("Health Care Reform"). Health Care Reform and the Interim Rule require group health plans to provide benefits for various preventive services for the first plan year beginning on or after September 23, 2010 (January 1, 2011 for calendar year plans) and prohibit the imposition of cost-sharing requirements for those services. Some of the services named in the Interim Rule that group health plans must provide without imposing cost sharing requirements include:

  • blood pressure and cholesterol screening
  • various immunizations for adults and children
  • diabetes screening for hypertensive patients
  • screening and counseling to reduce alcohol misuse
  • mammography screenings for women over age 40
  • interventions during pregnancy and after birth to promote and support breastfeeding
  • screening for colorectal cancer
  • screening for women over age 65 for osteoporosis
  • behavioral dietary counseling for adult patients with known risk factors for cardiovascular and diet-related chronic disease
  • screening for children over age six for obesity with referrals to comprehensive, intensive behavioral interventions to promote improvement in weight status
  • screening to detect defects in visual acuity in children younger than age 5
  • folic acid supplements for all women capable of pregnancy
  • screening for hearing loss and congenital hypothyroidism in all newborns
  • sexually transmitted infection screenings
  • counseling related to aspirin use and tobacco cessation.

The requirements of the Interim Rule do not apply to a group health plan that qualifies as a grandfathered plan under Health Care Reform so long as the plan maintains its grandfathered status.

A complete list of required preventive services can be found here. The Interim Rule may be accessed here.