US Department of Health and Human Services approves updates to list of preventative items and services to be covered without cost sharing | Ballard Spahr LLP

Revisions to preventive care and screening guidelines will require health plans and health insurance policies to provide 100% coverage for additional services for women, adolescents, children and infants, following an update released by the U.S. Department’s Health Resources Services Administration (HRSA). Health and Human Services (DHHS). The HRSA update also changes some other preventive care guidelines.

Recent updates from women’s health and for the health of minors require plans and insurers to treat the following items and services as preventative care under the Affordable Care Act and cover the cost of the items and services without any cost sharing (deductibles, co-payments, or coinsurance) by the people enrolled in a plan or policy:

  • Complete lactation consultation and double electric breast pumps for breastfeeding women, without the coverage being conditional on the failure of a manual breast pump.
  • Consultations on obesity for women between 40 and 60 years old.
  • For children and teens, assessments for sudden cardiac arrest and hepatitis B virus and screenings for certain behavioral health issues.

The new guidelines also revise, clarify and reformulate provisions relating to coverage of visits to healthy women, contraception, HIV testing and counseling on sexually transmitted diseases. Clarifications are also provided concerning fluoride varnish and supplementation in the pediatric dental recommendations.

The HRSA accepted the recommendations on Dec. 30, 2021. Under Affordable Care Act rules, health plans have one year to implement the changes and will be required to provide full coverage according to the recommendations for plan years beginning on or after December 30, 2022.

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