Sec. 4103 Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan
The ACA makes “health risk assessments” available to Medicare beneficiaries as part of their annual wellness visit. The Secretary is to encourage Health Information Technology use during these health risk assessments.54 Please see the Medicare section for more information.
Sec. 4202 Healthy Aging, Living Well; Evaluation of Community-Based Prevention and Wellness Programs for Medicare Beneficiaries
- Overview. The Secretary of Health and Human Services must evaluate community-based prevention and wellness programs that: (1) “are sponsored by the Administration on Aging;” (2) “are evidence based;” and (3) “have demonstrated potential to help Medicare beneficiaries…reduce their risk of disease, disability, and injury” through various lifestyle changes (e.g. diet and exercise).55
- Evidence Review. The Secretary will review evidence with a focus on “available evidence, literature, best practices, and resources that are relevant to programs that promote healthy lifestyles and reduce risk factors for the Medicare population.” The Secretary, at minimum, must review information on “physical activity, nutrition and obesity,” falls, chronic disease self-management, and mental health,” but may review additional information at their discretion. 56
- Program Evaluation. The Centers for Medicare & Medicaid Services (CMS), with help from the Assistant Secretary for Aging, will conduct a program evaluation. The evaluation will explore whether Medicare beneficiary participation in a community prevention and wellness program: (1) improves health, reduces risk, and leads to a healthy lifestyle; (2) improves the ability of beneficiaries to manage chronic conditions; and (3) reduces utilization of service and Medicare costs. 57
- Reporting and Funding. The Secretary must provide Congress with a report containing recommendations and findings by September 30, 2013. 58 Congress authorized funding to implement this section in the amount of 50 million dollars. The Secretary must obtain such funds from the Federal Hospital Insurance Trust Fund and the Federal Supplemental Insurance Trust Fund. 59
Sec. 4302 Understanding Health Disparities: Data Collection and Analysis
While administering their Medicaid and CHIP programs, States must collect and evaluate data regarding “disparities in health care services and performance on the basis of race, ethnicity, sex, primary language, and disability status.”60 Please see the Medicaid section for more information.
Footnotes
- 54. Affordable Care Act §4103(b); 42 U.S.C. 1395x(hhh).
- 55. Affordable Care Act §4202(b)(2)(A); 42 U.S.C. 300u-14(b)(2)(A).
- 56. Affordable Care Act §4202(b)(2)(B)(i); 42 U.S.C. 300u-14(b)(2)(B)(i).
- 57. Affordable Care Act §4202(b)(2)(B)(ii); 42 U.S.C. 300u-14(b)(2)(B)(ii).
- 58. Affordable Care Act § 4202(b)(3); 42 U.S.C. 300u-14(b)(3).
- 59. Affordable Care Act §4202(b)(4); 42 U.S.C. 300u-14(b)(4).
- 60. Affordable Care Act §4302(b); 42 U.S.C. 1396w-5.
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