Prevention in Health Reform

Affordable Care Act Prevention Timeline

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Many Americans do not receive the preventive health care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs.  Often because of cost, Americans use preventive services at about half the recommended rate.  Prevention is especially important for individuals with a mental illness or substance use disorder.  People with serious mental illness have shortened life-spans, on average living only until 53 years of age.  Additionally, up to 83 percent of people with serious mental illness are overweight or obese and 44 percent of all cigarettes consumed in the United States are by individuals with a mental illness or substance use disorder.  In fact, 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.1

Prevention and wellness are major components of the Affordable Care Act (ACA).  The ACA makes prevention affordable and accessible for all Americans through a number of different ways, including the elimination of cost sharing for preventive services, expanding preventive services for seniors through Medicare, issuance of grants to reduce chronic disease, the development of a National Prevention Strategy, grants to small employers for wellness programs, and providing resources to States to promote wellness and prevention.

Below you will find more information on prevention and how it affects the behavioral health field and helps those with mental health and substance use disorders.

HHS Initiatives and Actions Taken

National Prevention, Health Promotion and Public Health Council

The National Prevention, Health Promotion, and Public Health Council (National Prevention Council), called for by the Affordable Care Act, provides coordination and leadership at the federal level and among all executive agencies regarding prevention, wellness, and health promotion practices. It is composed of the heads of 17 federal agencies and chaired by Surgeon General Regina Benjamin.

With input from the public and interested stakeholders, the council developed a National Prevention and Health Promotion Strategy (National Prevention Strategy). The strategy provides an unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention. It presents a vision, goals, recommendations, and action items that individuals and public, private, and non-profit organizations can use to reduce preventable death, disease, and disability in the United States.  The National Prevention Strategy"s seven priorities all have a behavioral health component.  The seven priorities are:

U.S. Preventive Services Task Force exit disclaimer icon

The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). 

The USPSTF recommends that clinicians discuss these preventive services with eligible patients and offer then as a priority.  All these services have received an “A” (strongly recommended) or a “B” (recommended) grade from the Task Force.  If a service receives an “I” (insufficient evidence to make a recommendation), the USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing the service.  The USPSTF preventive service recommendations for behavioral health are:



Special Populations




Pregnant Women


Alcohol Misuse Screening and Behavioral Counseling Interventions




“I” (12 – 18 yrs)

Tobacco use and Tobacco-Caused Disease, Counseling and Intervention1




“I” (7 – 18 yrs)

Depression (Adults), Screening2





Major Depressive Disorder in Children and Adolescents, Screening3




“B” (12 – 18 yrs)
“I” (7 – 11 yrs)

HIV, Screening4




“A” (12 – 18 yrs)

1 Ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco; provide augmented, pregnancy-tailored counseling for those pregnant women who smoke.

2 When staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.

3 Adolescents (age 12 – 18) when systems are in place to ensure accurate diagnosis, psychotherapy, and follow-up.

4 All adolescents and adults at increased risk for HIB infection and all pregnant women.

Community Transformation Grants

Created by the Affordable Care Act, the Community Transformation Grants program supports states and communities that tackle the root causes of poor health so Americans can lead healthier, more productive lives. Grantees will use these funds to improve where Americans live, work, play, and go to school to reduce chronic diseases, such as heart disease, stroke and diabetes, which are a significant portion of the health care costs in the U.S. By promoting healthy lifestyles, especially among population groups experiencing the highest rates of chronic disease, these grants will help improve health, reduce health disparities, and control health care spending.  Find out more about the Community Transformation Grants!

Use the federal government"s Healthfinder website to learn the most important prevention steps you should take.  Just answer a few questions and you"ll find tips, tools, and information matched to your personal situation.

Prevention and Public Health Fund

The Affordable Care Act creates a new Prevention and Public Health Fund to assist state and community efforts to prevent illness and promote health, so that all Americans can lead longer, more productive lives.  The Fund represents an unprecedented investment – $15 billion over 10 years – that will help prevent disease, detect it early, and manage conditions before they become severe.  By concentrating on the causes of chronic disease, the Affordable Care Act helps move the nation from a focus on sickness and disease to one based on wellness and prevention.

The Prevention and Public Health Fund has already funding 56 primary and behavioral health care integration sites nation-wide and the SAMHSA – HRSA Center for Integrated Health Solutions exit disclaimer icon.  Additionally the Prevention and Public Health Fund has provided funding to improve wellness and prevention at the state level.  For information on what State activities check out the matrix below.

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Prevention Benefit Changes

Preventive Services – No Cost

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, some preventive services, including behavioral health services such as depression screening, alcohol misuse screening, alcohol and drug screenings for adolescents, and behavioral assessments for children of all ages, must be covered without your having to pay a copayment or co-insurance or meet your deductible.   This applies only when these services are delivered by a network provider.  This requirement does not apply to health plans that are "grandfathered"—meaning that existing health plans are exempt as long as they do not make changes to specific features detailed in regulation such as cost-sharing. However, as existing health plans make changes over the next several years, it is expected that eventually most plans will fall under the requirement.  More information on these services can be found at

Essential Health Benefits

Established by the Affordable Care Act, health plans sold through State and Federal Exchanges are required to offer at least the essential health benefits.   Preventive and wellness services and chronic disease management services are required categories as part of the essential health benefits package. 

The essential health benefits have not been determined yet, but recommendations from the Institute of Medicine (IOM) exit disclaimer icon have been released on the criteria and process for defining and updating essential health benefits that can be found on the IOM"s website.


As of January 1, 2011, many preventive services are under covered under Medicare if you get them from a doctor or other health care provider who accepts assignment.  The preventive services that qualify are the yearly wellness exam, tobacco cessation counseling and a number of different screenings.  For more information on these services visit the Medicare preventive services page on


Starting January 1, 2013, States will receive an increased Federal Medical Assistance Percentage (FMAP) for any clinical preventive services that are assigned a grade of A or B by the US Preventive Services Task Force, some adult immunizations and any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level.

Employer Wellness Programs

Grants will be awarded to eligible employers with less than 100 employees to provide their employees with access to comprehensive wellness workplace programs. This program is still under development and expected in 2014.

Additional SAMHSA prevention activities can be found on the SAMHSA Prevention Strategic Initiative Page.

World Health Organization (WHO). (2004). Promoting mental health: Concepts, emerging evidence, practice. Summary report. Geneva, Switzerland: WHO. Retrieved March 25, 2011, from exit disclaimer icon (PDF | 923Kb)

Last updated: 10/12/2011 button
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Did You Know?

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Research on California showed that treated patients reduce medical costs by 26%, and reduce ER visits by 36% when compared to a control group.

Source: Cost Offset of Treatment Services
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