HHS announces updates preventive care guidelines to reduce OOP expenses for women

The Department of Health & Human Services on Monday announced new preventive care and screening guidelines aimed at reducing expenses for women and children.

“Access to preventive care can help save countless lives and should be available without out-of-pocket costs, especially now during the COVID-19 pandemic,” HHS Secretary Xavier Becerra said. “These updated guidelines help ensure that we’re providing critical services to keep families healthy, based on the latest science and data available. The Biden-Harris Administration will continue to build on the Affordable Care Act to make preventive care available to as many Americans as possible nationwide.”

The Women’s Preventive Services Guidelines help clinicians determine what services they should routinely provide their patients. A multidisciplinary team of women’s health experts regularly reviews and recommends updates to the guidelines based on the newest research and public comments.

The Health Resources and Services Administration accepted recommended updates to existing guidelines regarding breastfeeding services and supplies; well-woman preventive care visits; access to contraceptives and contraceptive counseling; screening for human immunodeficiency virus; and counseling for sexually transmitted infections. These updates include, for the first time, requiring coverage without cost-sharing for double electric breast pumps. The HHS also approved a new guideline aiming to prevent and reduce obesity in midlife women (ages 40 to 60) through counseling.

The Bright Futures Program develops recommended evidence-informed guidelines for preventive care screenings and routine visits for newborns through adolescents up to age 21. The HRSA accepted updates to existing guidelines that include adding universal screening for suicide risk for individuals ages 12 to 21 and new guidance for behavioral, social and emotional screening. It also has accepted new guidelines for assessing risks for cardiac arrest or death for individuals ages 11 to 21 and assessing risks for hepatitis B virus infection in newborn to 21 year-olds.

Group health plans and insurance issuers subject to these requirements will be required to provide coverage without cost-sharing of new and updated services in the Women’s Preventive Services Guidelines and the Bright Futures Periodicity Schedule during plan years beginning in 2023.

“We are pleased to release these updated guidelines to expand insurance coverage of preventive services for women, infants, children and teenagers,” HRSA Administrator Carole Johnson said. “By requiring coverage with no cost-sharing for services like double-electric breast pumps for new parents and suicide risk screening for adolescents, these guidelines will help save lives and help families save money on out-of-pocket costs.”