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What Every Pediatrician Should Know About Health Care Reform

Below is what every Pediatrician should know about health care reform.  

The provisions listed below will have a direct impact on pediatric care and pediatricians need to take the time to familiarize themselves with the new regulations.

New Pediatric Regulations

Section 1001 Subsection 2713 – Coverage of Preventive Health Care
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1001 Subsection 2714 – Extension of Child Coverage
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 2004 – Medicaid Coverage for Former Foster Children
Medicaid coverage for former foster children who were in foster care under the responsibility of a State for more than 6 months.

Section 2302 – Concurrent Care for Children
A voluntary election to have payment made for hospice care for a child (as defined by the State) shall not constitute a waiver of any rights of the child to be provided with, or to have payment made under this title for, services that are related to the treatment of the child’s condition for which a diagnosis of terminal illness has been made.

Section 4204 – Immunizations
Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including–providing immunization reminders or recalls for target populations of clients, patients, and consumers;educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; reducing out-of-pocket costs for families for vaccines and their administration; carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; providing reminders or recalls for immunization providers;conducting assessments of, and providing feedback to, immunization providers; any combination of one or more interventions described in this paragraph; or immunization information systems to allow all States to have electronic databases for immunization records.

Section 5203 Subsection 775 – Pediatric Loan Forgiveness Program
The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.

Section 5501 – Expanded Access to Primary Care
Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
Every Pediatrician  needs to make sure that they take the time to familiarize themselves with the above regulations. To learn more, please click HERE

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  1. August 15, 2012 at 9:40 pm

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