With the recent Supreme Court decision to uphold the Affordable Care Act, there is much speculation on how this legislation will change clinical practice. While the unknowns are greater than what we currently understand about the ACA, the AASM has been analyzing what is in store for sleep medicine. Over the next several weeks, the AASM website will provide a synopsis of certain provisions in the bill. This week will focus on prevention and wellness.
Coverage of preventive services
- Eliminate cost-sharing for Medicare covered preventive services that are recommended by the U.S. Preventive Services Task Force and waive the Medicare deductible for colorectal cancer screening tests.
- Provide states that offer Medicaid coverage of and remove cost-sharing for preventive services recommended by the U.S. Preventive Services Task Force and recommended immunizations with a one percentage point increase in the federal medical assistance percentage (FMAP) for these services. (Effective January 1, 2013)
- Authorize Medicare coverage of personalized prevention plan services, including a comprehensive health risk assessment, annually. Reimburse providers 100 percent of the physician fee schedule amount with no adjustment for deductible or coinsurance for personalized prevention plan services when these services are provided in an outpatient setting.
- Provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs. Require Medicaid coverage for tobacco cessation services for pregnant women.
- Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents and additional preventive care and screenings for women.
- Establish the National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness, and public health activities. Develop a national strategy to improve the nation’s health. Create a Prevention and Public Health Fund to expand and sustain funding for prevention and public health programs. Create task forces on Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.
- Establish a Prevention and Public Health Fund for prevention, wellness and public health activities including prevention research and health screenings, the Education and Outreach Campaign for preventive benefits and immunization programs.
- Establish a grant program to support the delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas.
- Provide grants for up to five years to small employers that establish wellness programs. Provide technical assistance and other resources to evaluate employer-based wellness programs. Conduct a national worksite health policies and programs survey to assess employer-based health policies and programs.
- Permit employers to offer employees rewards—in the form of premium discounts, waivers of cost-sharing requirements or benefits that would otherwise not be provided—of up to 30 percent of the cost of coverage for participating in a wellness program and meeting certain health-related standards.
- Establish 10-state pilot programs by July 2014 to permit participating states to apply similar rewards for participating in wellness programs in the individual market and expand demonstrations in 2017 if effective. Require a report on the effectiveness and impact of wellness programs.