New Affordable Care Act Guidelines Improve Preventive Care for Women and Children
The Affordable Care Act (ACA) helps make preventive health coverage affordable and accessible for patients by requiring most insurers to provide coverage at no cost for certain recommended preventive services.
This means that preventive services with strong scientific evidence of their health benefits must be covered, and plans cannot charge a copayment, coinsurance or deductible for these services when they are delivered by a network provider.
Under the ACA, most private health insurers must provide coverage of women’s preventive healthcare – such as mammograms, screenings for cervical cancer, prenatal care and other services – at no charge per comprehensive federal guidelines supported by the Health Resources and Services Administration (HRSA).
The HRSA recently updated comprehensive preventive care and screening guidelines for women and children (from infancy through adolescence) to meet their unique healthcare needs. Among a number of updates, for the first time, the guidelines will require group health plans and insurers to provide coverage for new parents to receive double electric breast pumps and adolescents to receive suicide risk screening without a co-pay, coinsurance or deductible.
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a statement:
“Access to preventive care can help save countless lives and should be available without out-of-pocket costs, especially now during the COVID-19 pandemic. These updated guidelines help ensure that we’re providing critical services to keep families healthy, based on the latest science and data available.”
Guidelines for Women’s Preventive Care and Screenings
Effective December 30, 2021, HRSA accepted new guidelines regarding breastfeeding services and supplies, well-woman preventive care visits, access to contraceptives care visits, access to contraceptives and contraceptive counseling, screening for human immunodeficiency virus (HIV), and counseling for sexually transmitted infections (STIs).The HRSA also approved a new guideline aiming to prevent and reduce obesity in midlife women, ages 40 to 60, through counseling.
Overall, Women’s Preventive Services Guidelines help clinicians determine what services they should routinely provide their patients over a lifespan to improve their health and well-being.
Guidelines for Infants, Children and Adolescent Preventive Care and Screenings
On December 30, 2021, HRSA also accepted updates to guidelines for preventive care screenings and routine visits for newborns through adolescents. These updates include adding universal screening for suicide risk for individuals ages 12 to 21, and new guidance for behavioral, social and emotional screening. HRSA 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.
Based on recommendations from a team of pediatric primary care experts convened by the American Academy of Pediatrics, the Bright Futures Program provides evidence-informed guidelines for preventive care screenings and routine visits for children of all ages.
Group health plans and insurance issuers subject to these requirements will be required to provide coverage without cost-sharing of new and updated services during plan years beginning in 2023. The Centers for Medicare and Medicaid Services (CMS) offers further information on women’s preventive services coverage.
To learn more about the updated guidelines, visit:
https://www.hrsa.gov/womens-guidelines
https://aspe.hhs.gov/reports/aca-preventive-services-without-cost-sharing
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