IOM Issues Recommendations for Required Preventive Services
A new report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the services that health plans will cover at no cost to patients under Public Health Service Act Sec. 2713, as added by the Patient Protection and Affordable Care Act of 2010 (PPACA).
At the HHS's request, an IOM committee identified critical gaps in preventive services for women, as well as measures that will further ensure women's health and well-being. The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The committee identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions.
The report suggests the following additional services:
- screening for gestational diabetes;
- human papillomavirus (HPV) testing as part of cervical cancer screening for women who are older than age 30;
- counseling on sexually transmitted infections;
- counseling and screening for HIV;
- contraceptive methods and counseling to prevent unintended pregnancies;
- lactation counseling and equipment to promote breastfeeding;
- screening and counseling to detect and prevent interpersonal and domestic violence; and
- yearly well-woman preventive care visits to obtain recommended preventive services.
New Guidance Available for Early Retirement Reinsurance Program
The Centers for Medicare and Medicaid Services has published supplemental program guidance and has updated existing program guidance under the Early Retiree Reinsurance Program (ERRP).
The supplemental guidance further clarifies ERRP reimbursement policy by identifying certain International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes that are not acceptable as principal diagnosis codes and procedure codes that are not acceptable under Medicare. Therefore, medical items and services associated with ERRP claims that include any such diagnosis codes as a principal diagnosis code or procedure codes will not be credited toward the ERRP cost threshold and will not be reimbursed. The guidance related to the ICD-9 codes applies to every reimbursement request, regardless of whether the reimbursement request was initially submitted before or after the publication of the guidance, July 18, 2011.
CMS has also updated existing program guidance, Claims Ineligible for Reimbursement under the Early Retiree Reinsurance Program. CMS has incorporated additional excluded Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to this guidance document.
- These codes have also been added to the downloadable CSV file on the Regulations and Guidance page at http://www.errp.gov/.
- The additional ineligible procedures are listed at http://www.errp.gov/download/ERRP_Additional_Ineligible_Procedures_and_Diagnoses.pdf
The U.S. Department of Labor, Department of Treasury and Department of Health and Human Services released a correction of amendment to interim final rules with request for comments. The full text is available at http://www.gpo.gov/fdsys/pkg/FR-2011-07-26/pdf/2011-18820.pdf.
The amendment to the interim final rule is effective July 22, 2011. Public comments on the amendment to the regulations must be submitted on or before July 25, 2011.
The agencies also released additional guidance and revised model notices related to the amended interim final rules.
- Technical Release 2011-02
- Revised Model Notice of Adverse Benefit Determination
- Revised Model Notice of Final Internal Adverse Benefit Determination
- Revised Model Notice of Final External Review Decision
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