AAFP to CMS: Set Minimum Coverage Standards for Preventive Services

August 17, 2017 04:46 pm News Staff

Insurers need to recognize that access to preventive services and support for a healthy lifestyle are crucial to maintaining public health, the AAFP noted in a recent letter to CMS.

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To that end, the AAFP asked CMS Administrator Seema Verma, M.P.H., in an Aug. 9 letter(2 page PDF) signed by Board Chair Wanda Filer, M.D., M.B.A., of York, Pa., to require all insurance plans to cover all health prevention services that receive an "A" or "B" recommendation(www.uspreventiveservicestaskforce.org) from the United States Preventive Services Task Force.

The letter reminded CMS that the CDC has said, "Focusing on preventing disease and illness before they occur will create healthier homes, workplaces, schools and communities so that people can live long and productive lives and reduce their health care costs."

Examples of recommendations in the task force's "A" category include screening patients ages 50-75 years for colorectal cancer(www.uspreventiveservicestaskforce.org) and screening pregnant women for asymptomatic bacteriuria(www.uspreventiveservicestaskforce.org). Recommendations in the "B" category include diabetes screening for adults ages 40-70 years who are overweight or obese(www.uspreventiveservicestaskforce.org) and biennial screening mammography for breast cancer for women ages 50-74 years(www.uspreventiveservicestaskforce.org)

The letter, written in response to a resolution passed in 2016 by the Congress of Delegates, highlighted the importance of preventing disease and illness for patients of all ages.

For example, healthy children who exercise regularly spend more days at school and attain better academic achievement. A "B" recommendation from the task force call for obesity screening in children ages 6 and older(www.uspreventiveservicestaskforce.org) and for physicians to offer or refer intensive behavioral interventions for those who are diagnosed with obesity. One out of every three children(www.heart.org) is overweight or obese.

Adults need support for preventive services to reduce rates of asthma, high blood pressure, smoking and obesity, ailments that each reduce annual productivity between $200 and $440 per person. Seniors need support for mental and emotional health that will allow them to maintain an independent lifestyle at home.

"Investments in prevention across the lifespan complement and support treatment and care," the letter stated, quoting the CDC. "Prevention policies and programs can be cost-effective, reduce health care costs and improve productivity."