By Judith S. Palfrey, MD, FAAP
President, American Academy of Pediatrics
On Wednesday, I was honored to attend an event in DC unveiling the US Department of Health and Human Services’ (HHS) Interim Final Rule on preventive services under health reform. To so many of us in the business of taking care of children, the achievement of passing the law last March was a time of historic celebration, and now, as one of the most significant pieces of the law takes shape, we realize just how much better off our children will be under health reform.
One of the earliest provisions of the Patient Protection and Affordable Care Act to take effect is Section 2713, which requires health plans to cover, at absolutely no out-of-pocket cost to families, preventive care services outlined in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Supported by the Health Resources and Services Administration, Bright Futures is the definitive standard of pediatric well-child and preventive care developed by an evidence-informed, active collaboration led by the American Academy of Pediatrics (AAP).
Perhaps the best-known aspect of Bright Futures is the schedule of “well-baby and well-child visits” it establishes–31 visits between birth and age 21 years (to pediatricians and other clinicians, it is also known as the “periodicity schedule“). The interim rule clearly states that all components of pediatric well-child visits–including physical exams, immunizations, hearing and vision screening, developmental and behavioral screening, and anticipatory guidance–in accordance with the Bright Futures periodicity schedule must be free of financial barriers, including co-pays and deductibles. Insurers may not exclude any of these services from coverage, and cost-sharing cannot be imposed on families.
This landmark investment in preventive services will eventually allow all families, regardless of income, the opportunity to visit their pediatrician regularly during their children’s most critical years of development. Having coverage for the clinically appropriate well-child visits will allow pediatricians to identify and treat health problems in children before they start. This, in turn, should help bring down the prevalence of chronic conditions that place significant financial and physical strain on children and families.
The Academy will continue to work with HHS on the development of a Final Rule, and in the process, will continue to advocate for the following: all plans–including those retaining “grandfather status”–to cover Bright Futures services; Bright Futures to be appropriately integrated into other initiatives and standards, such as meaningful use and quality measures; and for insurance companies to eliminate cost-sharing while making up those dollars for pediatricians and other health care providers.
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