Obama administration unveils regulations requiring new healthcare plans to provide free preventive care

The Obama administration announced regulations on Wednesday requiring new healthcare plans to provide preventive care without charging co-pays, as called for in the healthcare reform law. The regulations were unveiled in tandem by first lady Michelle Obama, Jill Biden and Health and Human Services Secretary Kathleen Sebelius.

"Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure," Michelle Obama said in prepared remarks. "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."

Robert Zirkelbach, a spokesman for the industry group America's Health Insurance Plans, said the regulations "strike a very good balance" in terms of keeping health coverage affordable. While requiring plans to cover evidence-based preventive care for free — something he said many plans already do — the regulations are limited to new plans and in-network services. They also allow patients to be billed for the portion of their doctor's visit that isn't related to preventive care and permit "reasonable" limits on preventive services offered through care management programs.

The American Heart Association also applauded the new regulations.

"These new regulations will make disease prevention more accessible and affordable for all Americans and will help our organization reach its goal of optimum cardiovascular health for all Americans," the group said in a statement. "The association believes simple steps such as maintaining a healthy weight, being physically active, controlling blood pressure and cholesterol and choosing healthier foods will improve overall heart health. The new health reform law also eliminates cost-sharing for preventive services in Medicare and provides enhanced federal Medicaid matching funds to states for evidence-based preventive services. We look forward  to working with the Administration to put these provisions into place and will continue to educate the public about their benefits."

The regulations mandate that new health plans beginning on or after Sept. 23, 2010, must cover preventive services that have strong scientific evidence of their health benefits. Patients will no longer be charged a co-payment, co-insurance or deductible for these services when they are delivered by a network provider.

The recommendations, according to HHS, include:

• Evidence-based preventive services that earn an "A" or "B" grade from the U.S. Preventive Services Task Force, an independent panel of scientific experts that rates preventive services based on the strength of the scientific evidence documenting their benefits: 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 Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These 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, which are expected to be issued by Aug. 1, 2011.