HRSA Updates the Affordable Care Act Preventive Health Care Guidelines to Improve Care for Women and Children

Note: The updated ACA preventive health care guidelines for women include updates related to HIV screening and STI counseling. The resulting coverage without cost-sharing will help us achieve the goals of the STI National Strategic Plan and National HIV/AIDS Strategy for women.

Updates Will Result in Additional Services with No Out-of-Pocket Cost, Including Expanded Coverage for Breast Pumps and Adolescent Suicide Risk Screening

[Yesterday], the U.S. Department of Health & Human Services (HHS) announced that the Health Resources and Services Administration (HRSA) has updated comprehensive preventive care and screening guidelines for women and for infants, children, and adolescents. Under the Affordable Care Act (ACA), certain group health plans and insurance issuers must provide coverage with no out-of-pocket cost for preventive health services within these HRSA-supported comprehensive guidelines. Among a number of updates, for the first time the guidelines will require such group health plans and insurance plans to provide coverage without a co-pay or deductible for double electric breast pumps.

HHS is also releasing a new report from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) highlighting how the ACA has increased access to preventive care for millions of Americans, including vaccinations, contraception, and cancer screening. The ASPE report estimates that more than 150 million people with private insurance, including 58 million women and 37 million children, are receiving preventive services with no cost-sharing, as required by the ACA.

“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,” said HHS Secretary Xavier Becerra. “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.”

“We are pleased to release these updated guidelines to expand insurance coverage of preventive services for women, infants, children, and teenagers,” said HRSA Administrator Carole Johnson. “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.”

ACA Women’s Preventive Care and Screenings—Guidelines:

The Women’s Preventive Services Guidelines help clinicians determine what services they should routinely provide their patients. The Women’s Preventive Services InitiativeExit Disclaimer (WPSI) convenes a multidisciplinary team of women’s health experts to regularly review and recommend updates on a rolling basis to the guidelines based on the newest research and public comments, through a cooperative agreement with the American College of Obstetricians and Gynecologists (ACOG) funded by HRSA.

HRSA announced today that on December 30, 2021, it accepted updates to existing guidelines recommended by WPSI regarding breastfeeding services and supplies, well-woman preventive care visits, access to contraceptives and contraceptive counseling, screening for human immunodeficiency virus (HIV), and counseling for sexually transmitted infections (STIs). These updates include, for the first time, requiring coverage without cost-sharing for double electric breast pumps. HHS also approved a new guideline aiming to prevent and reduce obesity in midlife women (ages 40 to 60) through counseling.

Infants, Children and Adolescent Preventive Care and Screenings—Guidelines:

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 American Academy of Pediatrics (AAP) convenes a team of pediatric primary care experts with funding from HRSA to review scientific evidence and new standards annually and recommend updates to the Bright Futures Periodicity ScheduleExit Disclaimer based on the latest research and public comments.

On December 30, 2021, HRSA also accepted updates to existing Bright Futures guidelines. These updates include adding universal screening for suicide risk to the current Depression Screening category for individuals ages 12 to 21, and new guidance for behavioral, social and emotional screening. HRSA has also 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. The Centers for Medicare and Medicaid Services (CMS) offers further information on women’s preventive services coverage.

To learn more about the updated guidelines, visit: https://www.hrsa.gov/womens-guidelines

To find the ASPE report, visit: https://aspe.hhs.gov/reports/aca-preventive-services-without-cost-sharing