February 02, 2022

U.S. DHHS Approves Updates to the List of Preventive Items and Services to be Covered Without Cost-Sharing

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Key Takeaways

  • Health plans and health insurance policies must provide 100% coverage for certain services for women and minors.

Revisions to preventive care and screening guidelines will require health plans and health insurance policies to provide 100 percent coverage for additional services for women, adolescents, children, and infants, following an update issued by the Health Resources Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS). The HRSA update modifies certain other preventive care guidelines as well.

The recent updates for women's health and for minors' health require plans and insurers to treat the following items and services as preventive care under the Affordable Care Act and cover the cost of the items and services without any cost-sharing (deductibles, copayments, or coinsurance) by individuals enrolled in a plan or policy:

  • Comprehensive lactation consultation and double electric breast pumps for breast-feeding women, without coverage being predicated on the failure of a manual pump.
  • Obesity counseling for women between 40- and 60-years-old.
  • For children and adolescents, assessments for sudden cardiac arrest and the hepatitis B virus and screenings for certain behavioral health issues.

The new guidance also revises, clarifies, and restates the provisions for the coverage of well women visits, contraception, HIV screening, and counseling about sexually transmitted diseases. Clarifications are also made regarding fluoride varnish and supplementation in the pediatric dental recommendations.

HRSA accepted the recommendations on December 30, 2021. Consistent with Affordable Care Act rules, health plans have a year to implement the changes and will need to provide full coverage in line with the recommendations for plan years beginning on or after December 30, 2022.

Ballard Spahr attorneys in the Employee Benefits and Executive Compensation and Health Care practice groups are ready to assist plan sponsors and plan administrators in effectively navigating the ever-changing health law terrain.

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