Summary: The concepts of prevention and health promotion and even a paradigm shift away from a disease orientation is at the heart of much integrative practice. Thus an article in the June 2010 issue of the e-newsletter of the American Holistic Medicine Association (AHMA) is a useful document. Entitled simply “Prevention Provisions in HR 3590,” the article notes 10 separate places where the healthcare overhaul law, the Patient Protection and Affordable Healthcare Act, touches on the subject of prevention. Following AHMA permission, I re-print the article here. While there is little here yet that embodies a progressive approach to primary prevention, many are clearly steps in the right direction.
What does the Patient Protection and Affordable Healthcare Act of 2010, the healthcare overhaul legislation, say about prevention? Does that behemoth include any significant clinical shifts toward a prevention or health promotion? The Spring 2010 issue of the newsletter of the American Holistic Medical Association (AHMA) opens 8 specific windows into that document that help to answer this question. By approval from the AHMA, I reprint these here, with some commentary. This look at prevention-related sections of the overhaul on integrative practice is a companion piece to the May 12, 2010 Integrator resource entitled Reference Guide: Language/Sections on CAM and Integrative Practice in HR
Prevention Provisions in HR 3590
Now that the health care bill has passed, how did initiatives focused on prevention fare in the Patient Protection and Affordable Health Care Act (also known as HR 3590)? Below is a summary of the provisions that specifically focus on prevention:
Essential Health Benefits Requirements (Sec. 1302)
Includes an essential health benefits package that covers essential health benefits defined by the Secretary and limits cost sharing. Included in the general benefit categories are preventive and wellness services and chronic disease management, maternity and newborn care, mental health and substance use disorder services, and pediatric services.
Coverage of Preventive Health Services (Sec. 2713)
Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for:
(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force (USPSTF);
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the CDC with respect to the individual involved;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by Health Resources and Services Administration (HRSA);
(4) with respect to women, additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by HRSA.
Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan (Sec. 4103)
Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors. The personal prevention plan would take into account the findings of the health risk assessment and would be completed prior to or as part of a visit with a health professional. The personalized health advice and referral may include community-based lifestyle interventions to reduce health risks and promote self-management and wellness, as well as lists of risk factors and a screening schedule. Directs the Secretary to establish publicly available guidelines for health risk assessments, standards for interactive telephonic or web-based programs to furnish health-risk assessments, and a health risk assessment model.
Removal of Barriers to Preventive Services in Medicare (Sec. 4104)
Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the USPSTF. Clarifies that cost sharing for colorectal cancer screening services would be waived.
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Improving Access to Preventive Services for Eligible Adults in Medicaid (Sec. 4106)
The current Medicaid State option to provide other diagnostic, screening, preventive, and rehabilitation services would be expanded to include: (1) any clinical preventive service recommended with a grade of A or B by the USPSTF and (2) with respect to adults, immunizations recommended by the Advisory Committee on Immunization Practices and their administration. States that cover these additional services and vaccines, and also prohibit cost-sharing for such services and vaccines, would receive an increased Federal medical assistance percentage (FMAP) of one percentage point for these services.
Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid (Sec. 4107)
States would be required to provide Medicaid coverage for counseling and pharmacotherapy for tobacco cessation by pregnant women. Prohibits cost-sharing for these services.
Incentives for Prevention of Chronic Diseases in Medicaid (Sec. 4108)
Directs the Secretary to award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a healthy life-styles program and demonstrate changes in health risk and outcomes. The program shall be comprehensive, evidence-based, widely available, and easily accessible and shall be proposed by the state and approved by the Secretary. It shall be designed to address the needs of Medicaid beneficiaries to achieve: ceasing the use of tobacco; controlling or reducing weight; lowering cholesterol; lowering blood pressure; avoiding the onset of diabetes or improving management of diabetes. The programs shall last for 5 years. The section includes im-pact assessments, evaluation and reporting requirements. The section appropriates $100 million for the program, out of any funds not otherwise appropriated in the Treasury.
National Prevention, Health Promotion & Public Health Council (Sec. 4001)
Creates a Council within HHS to provide coordination and leadership at the Federal level, and among Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care in the US, and to develop the National Prevention Strategy. The Council shall be composed of departmental Secretaries from across the federal government, with the Surgeon Gen-eral serving as Chair.
National Prevention and Health Promotion Strategy (Sec. 4001)
Tasks the Council with creating a national strategy to: set goals and objectives for improving health through federally supported prevention, health promotion and public health programs, establish measurable actions and timelines to carry out the strategy, and make recommendations to improve Federal prevention, health promotion, public health and integrative health care practices.
Prevention and Public Health Fund (Sec. 4002)
Establishes a fund, to be administered through the Office of the Secretary at HHS, to provide for an expanded and sustained national investment in prevention and public health programs (over the FY 2008 level). The Fund will support programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs. Funding levels: FY 2010 – $500 million; FY 2011 – $750 million; FY 2012 – $1 billion; FY 2013 – $1.25 billion; FY 2014 – $1.5 billion; FY 2015 and each fiscal year thereafter- $2 billion.
Comment: The focus remains on early testing and immunizations, but one also finds in some place, like section 4108, support for clinical approaches to prevention that are organized around working with patients to help them make changes that will prevent occurrence (primary prevention) or re-occurrence (secondary prevention) of significant chronic problems. One wonders, down the road, if Non-Discrimination in Health Care – if it is not repealed by the American Medical Association, may also indirectly be a prevention influencer by expanding access to integrative practitioners who claim to focus on health-creating clinical strategies.
for inclusion in a future Your Comments Forum.