According to a News Release dated August 1, 2011, the U.S. Department of Health and Human Services (the “HHS”) has issued new guidelines under the Affordable Care Act. These new guidelines expand the list of preventive services that must be made available to women by a group health plan (except if the plan is “grandfathered”), without charging a co-payment, co-insurance or a deductible (a “cost share”).
The News Release says that, last summer, the HHS released new rules under the Affordable Care Act, requiring all (non-grandfathered) group health plans to cover several evidence-based preventive services for woman, like mammograms, colonoscopies, blood pressure checks, and childhood immunizations, without imposing a cost share. The Affordable Care Act also made recommended preventive services free for people on Medicare. The new guidelines expands the foregoing list of women’s preventive services to include:
–screening for gestational diabetes;
–human papillomavirus (HPV) DNA testing for women 30 years and older;
–sexually-transmitted infection counseling;
–human immunodeficiency virus (HIV) screening and counseling;
–FDA-approved contraception methods and contraceptive counseling;
breastfeeding support, supplies, and counseling; and
–domestic violence screening and counseling.
The (non-grandfathered) group health plans must provide these services, without imposing any cost sharing, for plan years beginning on or after August 1, 2012. The rules in the regulations governing coverage of preventive services, which allow plans to use reasonable medical management to help define the nature of the covered service, apply to women’s preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to impose cost sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.