The U.S. Department of Health & Human Services (HHS) announced that the Health Resources and Services Administration (HRSA) has updated comprehensive preventive care and screening guidelines for women and for infants, children, and adolescents.
Under the Affordable Care Act (ACA), certain group health plans and insurance issuers must provide coverage with no out-of-pocket cost for preventive health services within these HRSA-supported comprehensive guidelines. Among a number of updates, for the first time the guidelines will require such group health plans and insurance plans to provide coverage without a co-pay or deductible for double electric breast pumps.
HHS is also releasing a new report from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) highlighting how the ACA has increased access to preventive care for millions of Americans, including vaccinations, contraception, and cancer screening. The ASPE report estimates that more than 150 million people with private insurance, including 58 million women and 37 million children, are receiving preventive services with no cost-sharing, as required by the ACA.
ACA Women’s Preventive Care and Screenings—Guidelines:
HRSA announced today that on December 30, 2021, it accepted updates to existing guidelines recommended by WPSI regarding breastfeeding services and supplies, well-woman preventive care visits, access to contraceptives and contraceptive counseling, screening for human immunodeficiency virus (HIV), and counseling for sexually transmitted infections (STIs). These updates include, for the first time, requiring coverage without cost-sharing for double electric breast pumps. HHS also approved a new guideline aiming to prevent and reduce obesity in midlife women (ages 40 to 60) through counseling.
Infants, Children and Adolescent Preventive Care and Screenings—Guidelines:
The Bright Futures Program develops recommended evidence-informed guidelines for preventive care screenings and routine visits for newborns through adolescents up to age 21. The American Academy of Pediatrics (AAP) convenes a team of pediatric primary care experts with funding from HRSA to review scientific evidence and new standards annually and recommend updates to the Bright Futures Periodicity Schedule based on the latest research and public comments.
On December 30, 2021, HRSA also accepted updates to existing Bright Futures guidelines. These updates include adding universal screening for suicide risk to the current Depression Screening category for individuals ages 12 to 21, and new guidance for behavioral, social and emotional screening. HRSA has also accepted new guidelines for assessing risks for cardiac arrest or death for individuals ages 11 to 21 and assessing risks for hepatitis B virus infection in newborn to 21 year-olds.
Group health plans and insurance issuers subject to these requirements will be required to provide coverage without cost-sharing of new and updated services in the Women’s Preventive Services Guidelines and the Bright Futures Periodicity Schedule during plan years beginning in 2023. The Centers for Medicare and Medicaid Services (CMS) offers further information on women’s preventive services coverage.
