The federal Health Resources and Services Administration (HRSA) has endorsed new guidelines for the coverage of women’s preventive health care services applicable to group health plans. Although many group health plans already cover a range of women’s preventive health care services, employers and other plan sponsors will need to assess the scope of their plans’ coverage and the extent to which they apply any impermissible deductibles, copayments, and similar forms of participant cost-sharing requirements.
Fortunately, plan sponsors have time to conduct this evaluation with respect to the new guidelines, which take effect for plan years beginning on or after August 1, 2012. For calendar year plans, the effective date is January 1, 2013.
The guidelines emerge from the Patient Protection and Affordable Care Act (the 2010 health care reform legislation) and its requirement that health plans offer certain types of preventive health care services without cost-sharing by participants. To view our prior alert on the preventive services requirement, click here.
In announcing its support for new guidelines, the HRSA expressed its intent that the rules target certain services applicable to women’s health issues and fill gaps that exist in current guidance. The new rules do not supersede existing guidance, but specify that plans cover the following services without participant cost-sharing:
- Annual well-women visits (in some cases, additional visits should be covered)
- Screening for gestational diabetes for women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes
- High-risk human papillomavirus DNA testing, beginning at 30 years of age and no more frequently than every three years
- Annual counseling on sexually transmitted infections for all sexually active women
- Annual counseling and screening for human immunodeficiency virus infection for all sexually active women
- As prescribed, all Food and Drug Administration-approved contraceptive methods and sterilization procedures, along with patient education and counseling, with an exception for certain narrowly defined religious employers
- Breastfeeding support, supplies, and counseling in connection with each birth during pregnancy and the postpartum period, including rental fees for breastfeeding equipment
- Annual screening and counseling for interpersonal and domestic violence
The new guidelines have already stirred controversy regarding the cost of these mandates (and mandates yet to come) and the requirement that plans cover contraception (and the related exemption). In particular, plan sponsors may look out for guidance on the coverage that will need to be provided for essential health benefits.
If you have questions regarding these guidelines, please contact Edward I. Leeds at 215.864.8419 or leeds@ballardspahr.com.
As the federal health care reform effort gained steam, Ballard Spahr attorneys formed an initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting employers in understanding the relevant changes and planning for the future. For more information on the firm’s Health Care Reform Initiative, please click here.