ACA Preventive Care Updates Effective July 2015

The United States Preventive Services Task Force (USPSTF) added two recommendations regarding sexually transmitted infections counseling and low dose aspirin for preeclampsia prevention to be effective July 1, 2015, regardless of the group effective date. In addition, on May 11, 2015, CMS issued additional guidelines for women’s preventive care services, specifically regarding the coverage of female contraceptives, sex-specific recommended covered services, and genetic counseling for BRCA related cancer.

While the USPSTF recommendations and CMS FAQ 26 only apply to Non-Grandfathered (NG) plans, effective July 1, 2015 all of Health Net’s NG, GF+ and GF plans are in compliance with the USPSTF recommendations and the CMS guidance. As a reminder, NG and Grandfathered Plus (GF+) plans may not include a member cost share for preventive services. There are no changes to the preventive care flyer and no action is required on your part.

Additional Information about the new USPSTF Recommendations

• Sexually Transmitted Infections Counseling:  Under the ACA Preventive Care requirements for Women’s Preventive Services, Health Net plans already cover certain office visit services for sexually transmitted infections counseling under preventive benefits. Effective July, 1, 2015, additional CPT and HCPC codes have been included as preventive care services for NG and GF+ plans to comply with the latest USPSTF recommendations.
• Low Dose Aspirin for Preeclampsia Prevention is now covered as part of the ACA preventive care benefit for pregnant women. Effective July 1, 2015, the preventive care formulary was updated to remove any age restrictions for low does aspirin.

Additional Information about CMS FAQ 26

• BRCA Screening, Counseling and Testing Services: Per CMS FAQ 26, BRCA genetic testing and genetic counseling must be covered for a woman who has not been diagnosed with BRCA-related cancer, but who previously had breast, ovarian cancer or other types of cancer. Health Net plans began covering BRCA testing and genetic counseling as of January 1, 2014.
• Female Contraceptive Coverage: Insurers must cover at least one form of contraception in each of the 18 methods identified by the FDA in its current birth control guide. The coverage must include clinical services, patient education and counseling.
• Coverage of sex-specific recommended preventive services: Insurers may not limit gender-specific recommended preventive services based on an individual’s sex assigned at birth, gender identity or recorded gender.

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