CMS Implements Provisions for Improved Access to Preventive Care


The Centers for Medicare and Medicaid Services (CMS) today issued a final rule that will implement key provisions to expand preventive services for Medicare beneficiaries. The new policies, which will apply to payments for services provided on or after January 1, 2011, will eliminate some out-of-pocket costs and promote access to primary care services.

Preventive Screenings Available with No Out of Pocket Costs

The steps are critical toward improving the health status of Medicare beneficiaries, said CMS Administrator Donald Berwick MD. Included in the new benefits are annual wellness visits with a physician that will involve the development of a personalized plan for age-appropriate preventive care. Services will include screenings for cognitive impairment and weight and blood pressure measures. Additional services may be available at no charge depending upon the patient’s health status.

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Also included as a result of the Affordable Care Act is an elimination of copays, coinsurance, or deductibles for certain preventive care services for people with the Original Medicare. These include all that are recommended with a grade A or B by the US Preventive Services Task Force, such as flu shots, mammograms, tests such as colonoscopies and Pap tests, and cholesterol and bone mass measurements. (For a complete list, see here.)

This new ruling does not apply to those on private Medicare plans such as Medicare Advantage.

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The new CMS ruling for Medicare will also provide a 10% incentive for primary care practitioners, including family physicians, internists, geriatricians, nurse practitioners, clinical nurse specialists and physician assistance, for which primary care services represent 60 percent or more of their Medicare allowed charges. This change should help promote access by increasing the number of practitioners available to provide services, particularly in rural areas.

The final rule will appear in the November 29, 2010 Federal Register, issued by the Office of the Federal Register.