Summary
Authorizes HHS to change or remove coverage of certain preventive services. Clarifies that nothing in this section affects Medicare coverage of diagnostic or treatment services. Effective January 1, 2010.
Implementation Status
Prior to January 2013, CMS leveraged its authority pursuant to this provision to make select changes to preventive services on a case-by-case basis, as evidenced, for example, in the CY 2013 MPFS final rule.
On February 7, 2013, CMS released a report titled, The Affordable Care Act: A Stronger Medicare Program in 2012, in which it highlighted several of the reforms enacted under the ACA, including various Medicare Part D reforms, premium savings, preventive services (including the annual wellness visit provided for under the ACA, as well as tobacco cessation counseling, among others), and various program integrity related provisions.
As denoted above, under Title III, on July 8, 2013, CMS released its CY 2014 Medicare Physician Fee Schedule (MPFS) proposed regulation, which delineates proposed payment changes to physician payments, including among other things, a proposal to “modify coverage of AAA screening consistent with the recommendation of the USPSTF to eliminate the one-year time limit with respect to the referral for this service.” Comments on the underlying proposed regulation are due by September 6.
Statutory Text
SEC. 4105. EVIDENCE-BASED COVERAGE OF PREVENTIVE SERVICES IN MEDICARE. (a) AUTHORITY TO MODIFY OR ELIMINATE COVERAGE OF CERTAIN PREVENTIVE SERVICES.—Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: ‘‘(n) AUTHORITY TO MODIFY OR ELIMINATE COVERAGE OF CERTAIN PREVENTIVE SERVICES.—Notwithstanding any other provision of this title, effective beginning on January 1, 2010, if the Secretary determines appropriate, the Secretary may— ‘‘(1) modify— ‘‘(A) the coverage of any preventive service described in subparagraph (A) of section 1861(ddd)(3) to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force; and ‘‘(B) the services included in the initial preventive physical examination described in subparagraph (B) of such section; and ‘‘(2) provide that no payment shall be made under this title for a preventive service described in subparagraph (A) of such section that has not received a grade of A, B, C, or I by such Task Force.’’. (b) CONSTRUCTION.—Nothing in the amendment made by paragraph (1) shall be construed to affect the coverage of diagnostic or treatment services under title XVIII of the Social Security Act.