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Mondress Monaco Parr Lockwood PLLC
Mondress Monaco Parr Lockwood PLLC

Updated Guidance on Preventive Care Requirements

UPDATED GUIDANCE ON PREVENTIVE CARE REQUIREMENTS

The United States Preventive Services Task Force ("USPSTF") has revised several of its recommendations concerning preventive care services that must be covered by non-grandfathered group health plans subject to PPACA's preventive care requirements. The minimum preventive care coverage requirements under these revised recommendations are described below.

  • Hepatitis C (HCV) screening for persons at high risk for infection, and a one-time screening for hepatitis C infection in adults born between 1945 and 1965. This requirement is effective for plan years beginning on or after June 25, 2014.
  • The drugs tamoxifen and raloxifene for women at an increased risk of breast cancer. This requirement is effective for plan years beginning on or after September 24, 2014.
  • Interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. This requirement is effective for plan years beginning on or after August 27, 2014.

The latest updated USPSTF recommendations are available at http://www.uspreventiveservicestaskforce.org/uspstopics.htm.

In addition, in Part XIX of their FAQs about Affordable Care Act Implementation, IRS, DOL, and HHS recently provided an example of a smoking cessation benefit design that would be deemed compliant with the existing preventive care requirements for adults:

  • Screening for tobacco use; and
  • For individuals 18 and over who use tobacco products, two tobacco cessation attempts per year, with each tobacco cessation attempt consisting of the following coverage provided without precertification or prior authorization:
    • Four tobacco cessation counseling sessions of at least 10 minutes each
      (including telephone counseling, group counseling and individual counseling); and
    • A 90-day treatment regimen of FDA-approved tobacco cessation drugs, including both prescription and over-the-counter medications, prescribed by a health care provider.

The FAQ is available at http://www.dol.gov/ebsa/faqs/faq-aca19.html, Q/A-5.

Not intended as legal advice.