USPSTF and HRSA Issue Updated ACA Preventive Services Guidelines

The U.S. Preventive Services Task Force (USPSTF) and the Health Resources and Services Administration (HRSA) issued updated preventive services guidelines.

March 31, 2022

The USPSTF revised recommended preventive services for pediatric preventive dental care, and HRSA within the Department of Health and Human Services (HHS) issued updated preventive services guidelines for women. The ACA requires that most group health plans cover, without cost sharing, all preventive services with an A or B rating from the USPSTF, including those preventive services in HRSA’s Women’s Preventive Services Guidelines.

USPSTF Updated Recommendation Statement and other Updates

The USPSTF revised two recommended preventive services for pediatric preventive dental care.

  • The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride; and
  • The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.

Both recommendations are consistent with and reaffirm the previous USPSTF recommendations. Group health plans (with few exceptions) must adjust their plans to cover the following services service, without cost sharing, i.e., no copay, coinsurance, or deductible, effective for plan years beginning on or after December 7, 2022 (January 1, 2023 for calendar year plans):

The USPSTF also announced that they are developing a research proposal to assess preventive services for food insecurity. USPSTF recommendations follow a multi-step process that includes the development of a research plan, a review of the evidence, development of a draft recommendation, and finalizing the recommendation – with associated comment periods to incorporate feedback from the medical and research community, stakeholders, and the public.

While any final preventive service recommendation(s) related to food insecurity may be years away from publication, we wanted to highlight this proposed research plan as it represents the first time the USPSTF would focus recommendation research on a social determinant of health, and follows the publication of a 2021 article in the Journal of the American Medical Association (JAMA) describing the incorporation of social risk in Task Force recommendations.

HRSA Updated Women’s Preventive Services Guidelines

HRSA issued updated preventive services guidelines for women, including a new guideline related to the prevention of obesity, which were approved on December 30, 2021. Group health plans (with few exceptions) must adjust their plans to cover the following services service, without cost sharing, i.e., no copay, coinsurance, or deductible, effective for plan years beginning on or after December 30, 2022 (January 1, 2023 for calendar year plans):

  • Counseling to prevent obesity in women aged 40 to 69 years with normal or overweight body mass index (BMI);
  • Double electric breast pumps, pump parts and maintenance, and breast milk storage supplies;
  • The full range of women’s contraceptives listed in the recently updated Food and Drug Administration (FDA) Birth Control Guide;
  • Screening for HIV infection for all adolescent and adult women aged 15 and older at least once during their lifetime, and risk assessment and prevention education beginning at age 13; and
  • Pre- pregnancy, prenatal, postpartum, and interpregnancy well-woman visits.

Next Steps

The ACA requires that most group health plans cover, without cost sharing, all preventive services with an A or B rating from the USPSTF, including those preventive services in HRSA’s Women’s Preventive Services Guidelines.

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We provide this material for informational purposes only; it is not a substitute for legal advice.

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