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ACA Preventive Care Compliance Doesn't Stop with New Recommendations


  05:34:00 pm, by MedBen5   , 349 words,  
Categories: Wellness, Health Plan Management, Health Care Reform, Preventive care, Compliance

ACA Preventive Care Compliance Doesn't Stop with New Recommendations

Erin Kelly

Recently, we discussed here how MedBen helps to keep self-funded, non-grandfathered plans compliant with new preventive care requirements under the Affordable Care Act (ACA). However, it's not enough to just monitor new recommendations — we also continue to watch for any clarifications on existing recommendations.

As you may know, under the ACA, non-grandfathered health plans are required to cover preventive care recommendations at 100% when services are obtained through an in-network provider. The recommendations come from the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices, and guidelines supported by the Health Resources and Services Administration that are applicable to women and children.

From time to time, the Departments of Labor, Health and Human Services and the Treasury (the “Tri-Agencies”) will release joint FAQs that address commonly asked questions relating to federal acts, including the ACA. It is the goal of the Tri-Agencies to shed light on existing issues and regulations by offering clarifications on recommendations already in effect. Because these are clarifications and not new recommendations, the Tri-Agencies expect these changes to be made to health plans right away, unlike new recommendations which have a future implementation date.

For example, colonoscopies must be covered at 100% in-network under the ACA and have been for some time. A recent FAQ, released in April of 2016, specifies that any medically appropriate bowel preparatory medications that precede the colonoscopy must also be covered at 100%, when prescribed by a health care provider.

MedBen’s Compliance and Group Service Departments work together to make sure your self-funded plan complies with these requirements. Additionally, we will help you to understand the requirements and notify any necessary vendors, such as your pharmacy benefit manager, if applicable.

FAQs can be reviewed on the Department of Labor website.

A complete list of recommendations can be found at the following websites:

MedBen clients who have any questions about the requirements under the ACA are welcome to contact Compliance Supervisor Erin Kelly at

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