Wednesday, August 3, 2011

HHS announces guidelines for preventive services for women

In its latest release of rules implementing the Affordable Care Act, the Department of Health and Human Services (HHS) on Monday announced new guidelines on women’s preventive health services. Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women’s preventive health services without charging a co-payment, co-insurance or a deductible.

Last summer, HHS released new insurance market rules under the Affordable Care Act (ACA) requiring all new private health plans to cover several evidence-based preventive services like mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a copayment, deductible or coinsurance. The ACA also made recommended preventive services free for people on Medicare.

This announcement builds on that by making sure women have access to a full range of recommended preventive services without cost sharing, including "well woman" visits, screening for gestational diabetes, HIV screening and counseling, and breastfeeding support, including supplies and related counseling.

Contraceptives.  Also included in the list of preventive services is coverage for FDA-approved contraception methods and contraceptive counseling. The administration also released an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services. This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception.

Plan flexibility. The rules governing coverage of preventive services, which allow plans to use reasonable medical management to help define the nature of the covered service, also apply to women’s preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.

Effective date. New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012.

For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, including the full text of the law and additional information on health reform implementation and other recent developments in employee benefits, just click here.


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