Learn more about the updated Women's Preventive Services Guidelines and the MHPAEA Enforcement:
WOMEN'S PREVENTIVE SERVICES GUIDELINES UPDATED
The Department of Health and Human
Services’ (HHS) Health Resources and
Services Administration (HRSA) recently
updated its preventive services guidelines
to expand the list of women’s preventive
services that group health plans are
required to cover under the Affordable Care
Act (ACA).
Updated preventive services guidelines
generally take effect for plan years
beginning on or after one year from the
date the updated guideline is issued. In this
case, the updates take effect for plan years
beginning in 2023.
Updated Guidelines
The updated guidelines add one additional
service: Preventing Obesity in Midlife
Women
. The guideline recommends
counseling for midlife women aged 40 to 60
years with normal or overweight body mass
index to prevent obesity.
In addition, the update revises the following
five services:
• Breastfeeding Services and Supplies
.
Comprehensive lactation support
services during the antenatal, perinatal
and postpartum periods as well as
breastfeeding equipment and supplies.
• Contraception
. Access to the full range
of FDA-approved, -granted or -cleared
contraceptives and contraceptive care.
• Screening for HIV Infection
. HIV testing
for women aged 15 and older at least
once during their lifetime, and earlier or
additional screening based on risk.
• Counseling for Sexually Transmitted
Infections (STIs)
. Behavioral counseling
for sexually active adolescent and adult
women at an increased risk for STIs.
• Well-woman Preventive Visits
. At least
one preventive care visit per year
beginning in adolescence.
AGENCIES INDICATE FOCUS ON MHPAEA ENFORCEMENT
The Employee Benefits Security
Administration (EBSA) released a fact sheet
on 2021 enforcement of the Mental Health
Parity and Addiction Equity Act (MHPAEA),
which summarizes closed investigations of
MHPAEA violations in 2021. Federal
agencies also issued a 2022 Report to
Congress on the MHPAEA
highlighting their
recent emphasis on MHPAEA enforcement.
The MHPAEA prevents group health plans
and health insurance issuers that provide
mental health and substance use disorder
(MH/SUD) benefits from imposing less
favorable limits on those benefits than on
medical and surgical coverage. According to
the 2022 Report to Congress, health plans
and health insurance issuers are failing to
deliver parity for MH/SUD benefits.
Federal agencies indicated that they have significantly increased MHPAEA
enforcement activities
. In 2021, EBSA
investigated MHPAEA violations in the
following categories:
• Annual dollar limits and aggregate
lifetime dollar limits;
• Benefits in all classifications (MH/SUD
benefits generally must be provided in
every classification in which
medical/surgical benefits are provided);
• Financial requirements;
• Treatment limitations; and
• Cumulative financial requirements and
quantitative treatment limits.
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