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				   	PREVENTIVE CARE RULES ISSUED
				   	As part of last spring's enactment of the health care reform law, non -
				   	grandfathered plans are required to provide preventive care (such as
				   	mammograms, colonoscopies and immunizations) without cost - sharing. Now
				   	the IRS, DOL and the HHS have issued regulations implementing those
				   	preventive care service requirements. (Note: Grandfathered plans can avoid
				   	the preventive care service mandate. For information about grandfather status,
				   	please click here to access our Human Capital Practice Alert, Vol. 3, No 12,
				   	"Regulations on Grandfathered Plans."
				   	EFFECTIVE DATE
				   	As with the health care reform law's generally phased -in effective date, the
				   	regulations become effective with the first plan year after September 23, 2010
				   	(January 1, 2011 for calendar -year plans).
				   	ITEMS AND SERVICES
				   	Under the new rules group health plans must provide coverage for the items
				   	and services listed below. In addition, plans may not impose any cost - sharing
				   	requirements (such as a copayment, coinsurance or deductible) with respect to
				   	those items or services.
						•   	Evidence -based items or services that have in effect a rating of A or B
					    	in the current recommendations of the United States Preventive
					    	Services Task Force with respect to the individual involved
						•   	Routine immunizations for routine use in children, adolescents and
					    	adults that have in effect a recommendation from the Advisory
					    	Committee on Immunization Practices of the Centers for Disease
					    	Control and Prevention with respect to the individual involved
						•   	With respect to infants, children and adolescents, evidence- informed
					    	preventive care and screenings provided for in comprehensive
					    	guidelines supported by the Health Resources and Services
					    	Administration
						•   	With respect to women, to the extent not described above, evidence -
					    	informed preventive care and screenings provided for in
					    	comprehensive guidelines supported by the Health Resources and
					    	Services Administration
				   	OFFICE VISITS — SPECIAL RULES
						•   	If an item or service is billed separately from an office visit, then a plan
					    	may impose cost - sharing requirements with respect to the office visit.
						•   	If an item or service is NOT billed separately from an office visit, and
					    	the primary purpose of the office visit is the delivery of such an item or
					    	service, then a plan or issuer may NOT impose cost- sharing
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					    	requirements with respect to the office visit.
					 	•   	If an item or service described is NOT billed separately from an office
					    	visit and the primary purpose of the office visit is NOT the delivery of
					    	such an item or service, then a plan or issuer may impose cost - sharing
					    	requirements with respect to the office visit.
				   	OUT -OF- NETWORK PROVIDERS
				   	Unlike the emergency- services rule, nothing in the new regulations requires a
				   	plan that has a network of providers to provide preventive benefits or services
				   	that are delivered by an out -of- network provider. Moreover, nothing precludes
				   	a plan that has a network of providers from imposing cost - sharing
				   	requirements for preventive items or services that are delivered by an out -of-
				   	network provider.
				   	REASONABLE MEDICAL MANAGEMENT
				   	To the extent that the appropriate guideline for an item or service fails to
				   	specify, a plan can use reasonable medical management techniques to
				   	determine the frequency, method, treatment or setting for preventive services.
				   	SERVICES NOT DESCRIBED
				   	The regulations do not preclude a plan from providing coverage for items and
				   	services in addition to those recommended by the United States Preventive
				   	Services Task Force or the Advisory Committee on Immunization Practices of
				   	the Centers for Disease Control and Prevention, or provided for by guidelines
				   	supported by the Health Resources and Services Administration, or from
				   	denying coverage for items and services that are not recommended by that
				   	task force or that advisory committee, or under those guidelines.
				   	CHANGES IN RECOMMENDATIONS OR GUIDELINE
				   	A plan is not required to provide coverage for any items and services specified
				   	in any recommendation or guideline after the recommendation or guideline is
				   	no longer recommended by the appropriate group or agency.
				   	CONCLUSION
				   	As compared to other recently issued health care reform - related regulations,
				   	the preventive care regulations appear relatively straightforward. Happily the
				   	regulations appear to extend plans a bit of leeway to require co -pays or other
				   	cost - sharing for preventive care — as long as the particular treatments are not
				   	identified as covered under the appropriate agency requirements or are from
				   	an out -of- network provider. Even where non - grandfathered plans are entirely
				   	precluded from using cost - sharing tactics, items or services where cost sharing
				   	can be used should be easy to identify and, therefore, easier to administer.
				   	Finally, most commentators do not expect the cost of this mandate to be
				   	particularly onerous as measured against most other health care reform
				   	mandates.
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