Preventive Care & Federal Reform
Preventive Care for Women
On August 1, 2011, the Department of Health and Human Services (HHS) released an amendment to the Interim Final Regulations for preventive care under the Patient Protection and Affordable Care Act (PPACA). The amendment applies to non-grandfathered individual insurance policies as well as non-grandfathered insured and self-insured group health plans.
The amendment provides additional guidelines for women’s preventive services. Health plans will need to cover women’s preventive services, including birth control, without copayments or deductibles. The guidelines reflect the recommendations made last month by the independent Institute of Medicine.
For plan years beginning on or after August 1, 2012, non-grandfathered plans will be required to cover the following additional preventive care services for women with no cost sharing:
- Annual well-woman visits
- Screening for gestational diabetes
- HPV DNA testing for women 30 years and older
- Sexually-transmitted infection counseling
- HIV screening and counseling
- FDA-approved contraception methods and contraceptive counseling
- Breastfeeding support, supplies, and counseling
- Domestic violence screening and counseling
For more detail on the amendment and the additional preventive care services for women, visit: www.hrsa.gov/womensguidelines/.
Preventive Services Covered under the Affordable Care Act
If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or coinsurance or meet your deductible, when these services are delivered by a network provider.
Covered Preventive Services for Adults
Abdominal Aortic Aneurysm
one-time screening for men of specified ages who have ever smoked
Alcohol Misuse
screening and counseling
Aspirin
use for men and women of certain ages
Blood Pressure
screening for all adults
Cholesterol
screening for adults of certain ages or at higher risk
Colorectal Cancer
screening for adults over 50
Depression
screening for adults
Type 2 Diabetes
screening for adults with high blood pressure
Diet
counseling for adults at higher risk for chronic disease
HIV
screening for all adults at higher risk
Immunization
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
vaccines for adults--doses, recommended ages, and recommended populations vary:
Obesity
screening and counseling for all adults
Sexually Transmitted Infection (STI)
prevention counseling for adults at higher risk
Tobacco Use
screening for all adults and cessation interventions for tobacco users
Syphilis
screening for all adults at higher risk
Covered Preventive Services for Women, Including Pregnant Women
Anemia
screening on a routine basis for pregnant women
Bacteriuria
urinary tract or other infection screening for pregnant women
BRCA
counseling about genetic testing for women at higher risk
Breast Cancer Mammography
screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention
counseling for women at higher risk
Breast Feeding
interventions to support and promote breast feeding
Cervical Cancer
screening for sexually active women
Chlamydia Infection
screening for younger women and other women at higher risk
Folic Acid
supplements for women who may become pregnant
Gonorrhea
screening for all women at higher risk
Hepatitis B
screening for pregnant women at their first prenatal visit
Osteoporosis
screening for women over age 60 depending on risk factors
Rh Incompatibility
screening for all pregnant women and follow-up testing for women at higher risk
Tobacco Use
screening and interventions for all women, and expanded counseling for pregnant tobacco users
Syphilis
screening for all pregnant women or other women at increased risk
Covered Preventive Services for Children
Alcohol and Drug Use
assessments for adolescents
Autism
screening for children at 18 and 24 months
Behavioral
assessments for children of all ages
Cervical Dysplasia
screening for sexually active females
Congenital Hypothyroidism
screening for newborns
Developmental
screening for children under age 3, and surveillance throughout childhood
Dyslipidemia
screening for children at higher risk of lipid disorders
Fluoride Chemoprevention
supplements for children without fluoride in their water source
Gonorrhea
preventive medication for the eyes of all newborns
Hearing
screening for all newborns
Height, Weight and Body Mass Index
measurements for children
Hematocrit or Hemoglobin
screening for children
Hemoglobinopathies
or sickle cell screening for newborns
HIV
screening for adolescents at higher risk
Covered Preventive Services for Children - continued
Immunization
Diphtheria, Tetanus, Pertussis
Haemophilus influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella
vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
Iron
supplements for children ages 6 to 12 months at risk for anemia
Lead
screening for children at risk of exposure
Medical History
for all children throughout development
Obesity
screening and counseling
Oral Health
risk assessment for young children
Phenylketonuria (PKU)
screening for this genetic disorder in newborns
Sexually Transmitted Infection (STI)
prevention counseling for adolescents at higher risk
Tuberculin
testing for children at higher risk of tuberculosis
Vision
screening for all children
Source:
www.healthcare.gov