Much of the information about Medicare wellness visits was written by the folks at the Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration.
Their terminology is somewhat opaque. Here, "opaque" means "nearly impossible to understand"
We've tried to translate it into plain language on the Medicare Well Visit page
The Affordable Care Act provides for an Annual Wellness Visit (AWV), including Personalized Prevention Plan Services (PPPS) for Medicare beneficiaries as of January 1, 2011
Medicare coinsurance and Part B deductibles do not apply to the AWV.
The AWV will include the establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index (BMI) or waist circumference, and blood pressure (BP), with the goal of health promotion and disease detection and fostering the coordination of the screening and preventive services that may already be covered and paid for under Medicare Part B.
The initial AWV providing PPPS provides for the following services to an eligible beneficiary by a health professional:
•Establishment of an individual’s medical/family history.
•Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual.
•Measurement of an individual’s height, weight, BMI (or waist circumference, if appropriate), BP, and other routine measurements as deemed appropriate, based on the beneficiary’s medical/family history
•Detection of any cognitive impairment that the individual may have as defined in this section.
•Review of the individual’s potential (risk factors) for depression, including current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression, which the health professional may select from various available standardized screening tests designed for this purpose and recognized by national medical professional organizations.
•Review of the individual’s functional ability and level of safety based on direct observation, or the use of appropriate screening questions or a screening questionnaire, which the health professional may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations.
•Establishment of a written screening schedule for the individual, such as a checklist for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP), as well as the individual’s health status, screening history, and age-appropriate preventive services covered by Medicare.
•Establishment of a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an IPPE, and a list of treatment options and their associated risks and benefits.
•Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
•Voluntary advance care planning (as defined in this section) upon agreement with the individual.
•Any other element(s) determined appropriate by the Secretary of Health and Human Services through the National Coverage Determination (NCD) process.
In subsequent AWVs, the following services would be provided to an eligible beneficiary by a health professional:
•An update of the individual’s medical/family history.
•An update of the list of current providers and suppliers that are regularly involved in providing medical care to the individual, as that list was developed for the first AWV providing PPPS.
•Measurement of an individual’s weight (or waist circumference), BP, and other routine measurements as deemed appropriate, based on the individual’s medical/family history.
•Detection of any cognitive impairment that the individual may have as defined in this section.
•An update to the written screening schedule for the individual as that schedule is defined in this section, that was developed at the first AWV providing PPPS.
•An update to the list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are under way for the individual, as that list was developed at the first AWV providing PPPS.
•Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs.
•Voluntary advance care planning (as defined in this section) upon agreement with the individual.
•Any other element(s) determined appropriate by the Secretary of Health and Human Services through the National Coverage Determination (NCD) process.
