United States Preventative Services Task Force
Final Recommendation on CT Scans for High-risk Smokers
Who: High-risk smokers covered for insurance under Medicare, Medicaid or private insurance and subject to the Preventive Care requirements of the Patient Protection and Affordable Care Act (PPACA).
When: Starting January 1, 2015 or the beginning of their next plan year.
What: Based upon recent studies the United States Preventative Services Task Force (USPSTF) improved the grading of annual low-dose CT screening for individuals at high risk for lung cancer from an “I” to a “B Grade.” The grades are based on the quality and strength of the evidence about the potential benefits and harms of screening for this purpose.
Under PPACA preventive care services with grades of “A” and “B” are required to be covered without any patient cost sharing.
Executive Summary: In updated studies, the USPSTF found that low-dose CT scans more accurately identify early stage cancer than do other screening tests. They also found that many lung cancer deaths can be prevented by screening high-risk people every year.
High-risk can be defined as people who:
• are 55 through 80 years old, and
• have a history of heavy smoking, and
• are either current smokers or who have quit within the past 15 years.
Heavy smoking means a smoking history of 30 “pack years” or more. A “pack year” is smoking an average of 1 pack of cigarettes per day for 1 year. For example, a person could have a 30 pack-year history by smoking 1 pack a day for 30 years or 2 packs a day for 15 years.
USPSTF recommendations are significant because PPACA requires that any preventive services classified as A or B must be covered under insurance plans as Essential Health Benefits without any patient cost-sharing.
Actions: Employers Plan sponsors should consult with their agent, broker, plan consultant, legal counsel, or Human Resources Department to determine if and when any contract changes are required to satisfy the new preventive services requirement for lung cancer screenings. They should also assure that their employee notifications properly inform plan participants of any changes. Insurers will need to review their plan offerings to assure compliance.
The information presented and contained within this article was submitted by Ronald E. Bachman, Chairman of the IHC Editorial Advisory Board and President & CEO of Healthcare Visions. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult legal advisors to determine the laws and regulations in your state. Any opinions expressed within this document are solely the opinion of the individual author.