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