By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting
Under the ACA, non-grandfathered group health plans must provide benefits for “preventive care” on a first-dollar basis. This means such coverage must be provided at no cost to participants (i.e., no co-payments, co-insurance, or deductibles may be applied). For this purpose, preventive care includes:
- Evidence-based items or services with an A or B rating recommended by the United States Preventive Services Task Force (USPSTF);
- Immunizations for routine use for children, adolescents, or adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
- Evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children, and adolescents; and
- Other evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the HRSA for women.
The HRSA, which maintains responsibility for the comprehensive guidelines for women, recently issued new guidance that updates and expands the list of women’s preventive services. These revised guidelines apply to plan years beginning on or after December 30, 2022.
The updates to women’s preventive services include:
- A new guideline for counseling for women ages 40-60 with normal or overweight body mass index to prevent obesity.
- An expansion to the breastfeeding services and supplies guideline to include double electric breast pumps, their parts and maintenance, and breast milk storage supplies.
- An update to the list of women’s contraceptives found in the FDA Birth Control Guide.
- Revisions to the HIV screening guidelines that recommend (1) all women ages 15 and older receive HIV screening at least once during their lifetime, with earlier and/or additional risk-based screening and (2) that risk assessment and Preventive education begin at age 13.
- Updates to the well-women Preventive visits to include pre-pregnancy, prenatal, postpartum, and interpregnancy visits.
A full list of women’s preventive services guidelines can be found on the HRSA’s website.