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In neighborhoods all across the country, people are gathering for presentations from the new state health insurance marketplaces established by the Affordable Care Act. One thing they might hear as they get oriented to the new system, is that all plans offered under the new act are required to include full coverage, with no co-pay, for all services graded A or B by the U.S. Preventive Services Task Force.
It's a detail that might just slip by in the face of the boatload of information coming at us, but among this list of some fifty items, many of which recommend preventive screenings, counseling or supplements, there is one item which may have significant implications for Tai Chi teachers, and it's the only recommendation that that mentions exercise:
"Falls prevention in older adults: exercise or physical therapy. The USPSTF recommends exercise or physical therapy to prevent falls in community-dwelling adults age 65 years and older who are at increased risk for falls."
Does this mean that health insurance will now fully cover the costs of the Tai Chi classes intended for preventing falls? Well, maybe, at least for some. Let's look at the details:
The relevant part of the Affordable Care Act, more properly Public Law 111-148, entitled "The Patient Protection and Affordable Care Act," says in section 2713 under "COVERAGE OF PREVENTIVE HEALTH SERVICES,"
"(a) In General.--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--
"(1) 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."
The United States Preventive Services Task Force has been around since 1984, and is "an independent, volunteer panel of national experts in prevention and evidence-based medicine." The recommendation of exercise for fall prevention shown above has a rating of grade B, meaning that, "The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial."
This represents a huge potential opportunity for people who do Tai Chi. It has been widely proved and acknowledged that Tai Chi can be very effective in preventing falls.
For example, the CDC's 2008 guide "Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults," Tai Chi is the only specifically recommended form of exercise:http://www.cdc.gov/homeandrecreationalsafety/images/cdc_guide-a.pdf
In the meantime, bear in mind that adults age 65 and older are eligible for Medicare. Some will have additional insurance through employers, so it's unlikely that many of them will be buying into the new health plans becoming available. But this brings us to another related issue.
Although the Affordable Care Act states that Medicare must now pay 100 percent for those preventive services it currently provides which are graded A or B by USPSTF, it turns out that Medicare does NOT have to provide coverage for all of USPSTF's A and B graded services. To make matters worse, the Centers for Medicare and Medicaid Services (CMS.gov) acknowledges on their website that "several preventive services covered by Medicare do not have a USPSTF recommendation grade of A or B."
Confused?
So were the folks in the Department of Family Medicine at UCLA, who, in a paper published in the Annals of Family Medicine in 2011 noted that although 14 of the 15 recommended preventive interventions for adults aged 65 years and older were partially reimbursed by Medicare, only one of the 15 was fully reimbursed (the exercise for fall prevention recommendation was not added to the USPSTF list until May, 2012). And, USPSTF recommended against 16 preventive services which, at least at the time of the study, Medicare did reimburse. The study concluded, "Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries."
The bottom line: we're not there yet, but we're definitely getting closer. The Affordable Care Act has raised awareness of the USPSTF's preventive services list, and the growing trend is to focus on prevention, particularly when it has a high benefit to cost ratio, which we all know Tai Chi does!
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