By Jueseppi B.
Effective On August 1, 2012
- All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Women’s Preventive Services – including well-woman visits, support for breastfeeding equipment, contraception and domestic violence screening – will be covered without cost sharing.
Effective August 1, 2005, Nutritional Supplements (Enteral Feeding Formulas), Insulin Syringes, Blood Glucose Meters and Blood Glucose Strips are covered under the Durable Medical Equipment Program (DME) and must be billed using CMS form 1500 with HCPCS codes.
Today (August 1) marks an historic step forward for women across Massachusetts and the United States. From this point on, new health insurance plans must begin covering women’s preventive services like contraception, breastfeeding counseling and support, and screenings for sexual transmitted diseases, including HIV and HPV without charging any additional costs, like co-pays. As exciting as these new services are, the underlying message is that women’s basic health care is just that—basic health care. And now basic health care must be available to every woman regardless of where she lives or how much she earns. This change in how we define preventive care is the most vitally important part of “ObamaCares”.
Women’s Preventive Services: Required Health Plan Coverage Guidelines
Affordable Care Act Expands Prevention Coverage for Women’s Health and Well-Being
The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover preventive services and by eliminating cost sharing. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.
Women’s Preventive Services: Required Health Plan Coverage Guidelines Supported by the Health Resources and Services Administration
Under the Affordable Care Act, women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – is covered with no cost sharing for new health plans. However, the law recognizes and HHS understands the need to take into account the unique health needs of women throughout their lifespan.
The HRSA-supported health plan coverage guidelines, developed by the Institute of Medicine (IOM), will help ensure that women receive a comprehensive set of preventive services without having to pay a co-payment, co-insurance or a deductible. HHS commissioned an IOM study to review what preventive services are necessary for women’s health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women. HRSA is supporting the IOM’s recommendations on preventive services that address health needs specific to women and fill gaps in existing guidelines.
Health Resources and Services Administration Supported Women’s Preventive Services: Required Health Plan Coverage Guidelines
Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.
Type of Preventive Service HHS Guideline for Health Insurance Coverage Frequency Well-woman visits.
Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713.Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.
* (see note) Screening for gestational diabetes. Screening for gestational diabetes.In pregnant 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.
Human papillomavirus testing.
High-risk human papillomavirus DNA testing in women with normal cytology results.Screening should begin at 30 years of age and should occur no more frequently than every 3 years.
Counseling for sexually transmitted infections.
Counseling on sexually transmitted infections for all sexually active women.Annual.
Counseling and screening for human immune-deficiency virus.
Counseling and screening for human immune-deficiency virus infection for all sexually active women.Annual.
Contraceptive methods and counseling.
** (see note)All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.As prescribed.
Breastfeeding support, supplies, and counseling.
Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.In conjunction with each birth.
Screening and counseling for interpersonal and domestic violence.
Screening and counseling for interpersonal and domestic violence.Annual.
August 1: Women’s Health Care Package Implementation Is Cause for Celebration and Caution
By Ms. Nancy K. Kaufman
August 1 is a great day for women. It marks the roll-out of the Affordable Care Act (ACA) package of preventive and diagnostic care that must now be included without co-pays or deductibles as a part of every policy provided to employees by their employer. But while we celebrate, a note of caution is in order, because opponents of the new law have vowed to continue to do everything they can think of to dismantle health care reform.
First, the good news is that the new benefits mean that women can now get a free well-woman visit every year to obtain standard preventive services, and additional ones as needed. Pregnant women can be screened for gestational diabetes as appropriate, and women 30 or older can get testing every three years that can help reduce the prevalence of cervical cancer. Sexually active women can access free counseling regarding sexually transmitted infections (STIs) and obtain free HIV/AIDS testing — critical since women have suffered a 15 percent increase in AIDS cases from 1999-2003 (dramatically more for women of color), while cases among men rose only one percent.
Family planning is an essential service that improves maternal health and leads to healthier babies. Starting August 1 under ACA, women, with the limited exception for those working for pervasively religious employers, will have access to all contraceptive methods approved by the Food and Drug Administration as well as to sterilization procedures and to related patient education. And pregnant and postpartum women will have access to the counseling and equipment needed for breastfeeding — one of the most effective ways mothers can protect both their children’s health and their own.
Finally, the ACA will ensure coverage of screening and counseling for interpersonal and domestic violence. One-quarter of women report that they have experienced intimate partner violence during their lifetimes. Screening has proved effective in the early detection of such violence and leads to effective interventions to increase the safety of abused women.
That’s the good news. The bad news is that there are still committed opponents of health care reform — dead-enders — who want to prevent, undercut, or dismantle nearly all of what health care reform has to offer. The House of Representatives has voted at least 33 times to repeal the Affordable Care Act, the latest instance being July 11. Now House Republicans haveproposed to delete all funding for the law from the 2013 fiscal year budget, and they even propose to rescind current funding for several of the law’s programs.
At the state level, opponents are fighting the expansion of Medicaid in 2014 that will insure up to 17 million more poor and working class people, a majority of whom will be women. In fact the majority of women who will be newly insured when ACA takes full effect in 2014 will gain coverage through an expanded and improved Medicaid program that states can opt into. It will be funded primarily by the federal government and administered by the states. But, according to the recent Supreme Court ruling, states don’t have to take the new money, and several governors have announced that they won’t, leaving millions still without access to adequate affordable health care.
And the contraception controversy has not gone away. Despite the administration’s fix that will allow insurance companies to pay for contraceptive coverage — taking religiously affiliated employers out of the process– the issue is still alive in the courts. While one lawsuit seeking to overturn the law, filed by Nebraska, Florida, Michigan, Ohio, Oklahoma, South Carolina and Texas, was just tossed out by a federal district court judge, 12 others have been filed by 43 Catholic organizations (and now one evangelical college). The plaintiffs include several dioceses, social services providers, and educational institutions that contend the contraceptive requirement violates their conscience as employers. NCJW and many others believe that women employees should not have their health care decisions dictated by their employers’ religious beliefs.
So we celebrate August 1 with some trepidation. The new package of care for women without extra out-of-pocket cost represents a huge step forward. But the ongoing, relentless campaign against health care reform continues unabated. The debate before the Supreme Court and elsewhere rarely mentions those without health care and the misery, suffering, and economic ruination that results from out of control medical costs. Those of us who believe in this law must exercise unrelenting vigilance to keep it alive. Literally millions of women are depending on us.
“BARACK” The Vote