The health reform law doesn't only provide for expanded coverage of health care, strong measures are included to start various prevention and wellness initiatives. Some of these initiatives begin in 2011. But as previously reported in DOTmed CMS has already announced a proposed rule, on some of these prevention measures. The prevention and wellness measures slated to begin in 2011 are discussed in detail below.



Medicare Deductibles Waived

One of the most significant changes is that Medicare deductibles for covered preventive services recommended by the U.S. Preventative Services Task Force (rated A or B) and for colorectal cancer screening tests will be waived.

Next, the Department of Health and Human Services will set up an ambitious program--providing Medicare coverage for an annual wellness visit for beneficiaries, which will provide both a personalized prevention plan and health risk assessment.

The health risk assessment would be completed prior to or as part of the same visit. The prevention plan will take into account the results of the health risk assessment, including:

--Establishment of, or an update to, the individual's medical and family history;

--A list of current providers and all prescribed medications;

--Measurements of height, weight, body mass index, blood pressure, and other routine measurements;

--Detection of any cognitive impairment.

The plan will also establish or update a screening schedule for the next 5 to 10 years based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, the patient's health status, screening history, and age-appropriate preventive services.

The plan will take into account any risk factors and conditions for which prevention interventions are recommended or are underway, including any mental health conditions or risk factors that have been identified through an initial preventive physical examination, and a list of treatment options and their associated risks and benefits.

The plan will also have personalized health advice and referrals to health education or preventive counseling services, to programs aimed at reducing identified risk factors and improving self-management, or to community-based lifestyle interventions to reduce health risks and promote self-management and wellness. These wellness factors may be weight loss, physical activity, smoking cessation, fall prevention, and nutrition.

HHS, within one year after the date of the Affordable Care Act, shall establish publicly available guidelines for the health risk assessments. The guidelines will be developed in consultation with relevant groups and entities to ensure that a health risk assessment can identify chronic diseases, injury risks, modifiable risk factors, and urgent health needs of the individual.

HHS will also establish standards for interactive telephonic or internet programs used to furnish health risk assessments. HHS will encourage involving health information technology in this program.

Grants for Small Employer Wellness Programs

HHS will award grants to eligible employers to provide their employees with access to comprehensive workplace wellness programs. The grant programs will be conducted for five years. An eligible employer is one who employs fewer than 100 employees who work 25 hours or more per week and does not currently provide a workplace wellness program.

HHS will develop program criteria consistent with evidence-based research and best practices. $200,000,000 is appropriated for the program. An eligible employer's program will include:

--Health awareness initiatives (including health education, preventive screenings, and health risk assessments);

--Efforts to maximize employee engagement (including mechanisms to encourage employee participation);

--Initiatives to change unhealthy behaviors and lifestyle choices (including counseling, seminars, online programs, and self-help materials);

--Supportive environment efforts (including workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity, and improved mental health).

Any eligible employer who wants to participate in the grant program will be required to submit an application to HHS, including a proposal for a comprehensive workplace wellness program that meet the criteria. The funding for this measure should begin in fiscal year 2011.

Vending Machines and Chain Restaurants Labeling

Finally, chain restaurants and food items in vending machines will be required to disclose nutritional information labeling. Regulations for this measure should be published within one year of the Affordable Care Act's enactment. For restaurants, the provision applies to establishments that are part of a chain with 20 or more locations. The information to be disclosed by restaurants--in a clear and obvious manner, includes:

--The number of calories contained in each standard menu item and prepared for sale;

--A statement with suggested daily caloric intake posted prominently on the menu, for the public to understand, with explanation of caloric information in the context of a daily diet;

--A nutrient content disclosure statement close to the name of a standard menu item with number of calories;

--A written version of the nutrition information on the food items;

--Clear and conspicuous notification of the availability of the written version.

For self-service food and food on display (such as a salad bar, buffet line, cafeteria line), the establishment will be required to place next to each food item a sign that lists the calories per item or serving. The establishment will need to use reasonable means for determining the calories, such as nutrient databases, lab analysis, cookbooks, and other sources.

Regulations will be established of standards for determining nutrient content of standard menu items that have different flavors, varieties and combinations but are listed as a single menu item-such as soft drinks, ice cream, pizza, doughnuts, or children's combination meals. However, the law does not apply to items not on the menu (such as condiments) and daily specials and other temporary menu items.

In the case of vending machines, a vending machine operator will be required to provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories contained in the article.

Early Retiree Reinsurance Program

In other health reform news, HHS has announced that its Office of Consumer Information and Insurance Oversight is accepting applications for the Early Retiree Reinsurance Program. This is a measure in the Affordable Care Act to reimburse employers for medical claims for retirees age 55 and older who are not eligible for Medicare, and their spouses, surviving spouses, and dependents. Any employers who provide health coverage for early retirees are eligible to apply.

HHS says reimbursements will be available for 80 percent of medical claims costs for health benefits between $15,000 and $90,000. Program participants can submit claims for medical care from June 1, 2010.

HHS plans additional application assistance including a webinar to be available online this week.

More on the Early Retiree Reinsurance Program:
http://www.hhs.gov/news/press/2010pres/06/20100629a.html