Adjusted Community Rating under PPACA is explained here, what Employers and Individuals need to know.
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As you may know, the health care reform law includes a provision requiring health insurers to cover preventive services with no member cost sharing. Recently-published interim final regulations clarify this provision. Non-grandfathered plans issued or renewed on or after September 23, 2010, will not include member cost sharing or copays for the following preventive care provided in-network:
- Evidence-based items or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force.
- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
- For infants, children and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
- For women, to the extent not otherwise addressed by the United States Preventive Services Task Force recommendations, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
Other key points:
- This impacts non-grandfathered plans issued or renewed on or after September 23, 2010.
- This applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.
- Most of the recommended screenings, immunizations and exam services are already on our preventive services list. We are adding the new, required preventive services to this existing list.
- An example of a new preventive service is counseling related to aspirin use, tobacco cessation, obesity and alcohol use.
- Some services currently covered as medical/maternity will now be considered preventive services. This includes several recommended screenings for pregnant women.
As with the other provisions in the health care reform law, we’re committed to implementing this provision in a manner that helps members have access to quality health care services. If you have any questions, talk with your sales representative.