83 FR 8487 - Women's Preventive Services Guidelines

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

Federal Register Volume 83, Issue 39 (February 27, 2018)

Applicable as of December 29, 2017, HRSA updated the HRSA- supported Women's Preventive Services Guidelines for purposes of health insurance coverage for preventive services that address health needs specific to women based on clinical recommendations from the Women's Preventive Services Initiative. This 2017 update adds two additional services--Screening for Diabetes Mellitus after Pregnancy and Screening for Urinary Incontinence--to the nine preventive services included in the 2016 update to the HRSA-supported Women's Preventive Services Guidelines. The nine services included in the 2016 update are as follows: Breast Cancer Screening for Average Risk Women, Breastfeeding Services and Supplies, Screening for Cervical Cancer, Contraception, Screening for Gestational Diabetes Mellitus, Screening for Human Immunodeficiency Virus Infection, Screening for Interpersonal and Domestic Violence, Counseling for Sexually Transmitted Infections, and Well-Woman Preventive Visits. This notice serves as an announcement of the decision to update the guidelines as listed below. Please see https://www.hrsa.gov/womens-guidelines/index.html for additional information.

[Federal Register Volume 83, Number 39 (Tuesday, February 27, 2018)]
[Notices]
[Pages 8487-8488]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-03840]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Service Administration


Women's Preventive Services Guidelines

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: Applicable as of December 29, 2017, HRSA updated the HRSA-
supported Women's Preventive Services Guidelines for purposes of health 
insurance coverage for preventive services that address health needs 
specific to women based on clinical recommendations from the Women's 
Preventive Services Initiative. This 2017 update adds two additional 
services--Screening for Diabetes Mellitus after Pregnancy and Screening 
for Urinary Incontinence--to the nine preventive services included in 
the 2016 update to the HRSA-supported Women's Preventive Services 
Guidelines. The nine services included in the 2016 update are as 
follows: Breast Cancer Screening for Average Risk Women, Breastfeeding 
Services and Supplies, Screening for Cervical Cancer, Contraception, 
Screening for Gestational Diabetes Mellitus, Screening for Human 
Immunodeficiency Virus Infection, Screening for Interpersonal and 
Domestic Violence, Counseling for Sexually Transmitted Infections, and 
Well-Woman Preventive Visits. This notice serves as an announcement of 
the decision to update the guidelines as listed below. Please see 
https://www.hrsa.gov/womens-guidelines/index.html for additional 
information.

FOR FURTHER INFORMATION CONTACT: Kimberly C. Sherman, Maternal and 
Child Health Bureau, HRSA at phone: (301) 443-0543; email: 
[email protected].

SUPPLEMENTARY INFORMATION: The complete set of updated 2017 HRSA-
supported Women's Preventive Services Guidelines includes those that 
were accepted by the Acting HRSA Administrator on December 20, 2016, as 
well as two new services, Screening for Diabetes Mellitus After 
Pregnancy and Screening for Urinary Incontinence. For a complete 
listing and detailed information about the December 20, 2016, updates, 
please see https://www.federalregister.gov/documents/2016/12/27/2016-31129/updating-the-hrsa-supported-womens-preventive-services-guidelines. In addition, the December 20, 2016, updates, including 
information related to coverage of contraceptive services and exemption 
for objecting organizations from requirements related to the provision 
of contraceptive services, can be found at https://www.hrsa.gov/womens-guidelines-2016/index.html. Information regarding the two new services 
that were accepted by the HRSA Administrator on December 29, 2017, is 
set out below:

1. Screening for Diabetes Mellitus After Pregnancy

    The Women's Preventive Services Initiative recommends women with a 
history of gestational diabetes mellitus (GDM) who are not currently 
pregnant and who have not previously been diagnosed with type 2 
diabetes mellitus should be screened for diabetes mellitus. Initial 
testing should ideally occur within the first year postpartum and can 
be conducted as early as 4-6 weeks postpartum.
    Women with a negative initial postpartum screening test result 
should be rescreened at least every 3 years for a minimum of 10 years 
after pregnancy. For women with a positive postpartum screening test 
result, testing to confirm the diagnosis of diabetes is indicated 
regardless of the initial test (e.g., oral glucose tolerance test, 
fasting plasma glucose, or hemoglobin A1c). Repeat testing is indicated 
in women who were screened with hemoglobin A1c in the first six months 
postpartum regardless of the result (see Implementation Considerations 
below).

2. Screening for Urinary Incontinence

    The Women's Preventive Services Initiative recommends screening 
women for urinary incontinence annually. Screening should ideally 
assess whether women experience urinary incontinence and whether it 
impacts their activities and quality of life. The Women's Preventive 
Services Initiative recommends referring women for further evaluation 
and treatment if indicated.

HRSA-Supported Women's Preventive Services Guidelines

    The HRSA-supported Women's Preventive Services Guidelines were 
originally established in 2011 based on recommendations from an HHS 
commissioned study by the Institute of Medicine, now known as the 
National

[[Page 8488]]

Academy of Medicine (NAM). Since then, there have been advancements in 
science and gaps identified in the existing guidelines, including a 
greater emphasis on practice-based clinical considerations. To address 
these, HRSA awarded a 5-year cooperative agreement in March 2016 to 
convene a coalition of clinician, academic and consumer-focused health 
professional organizations and conduct a scientifically rigorous review 
to develop recommendations for updated Women's Preventive Services 
Guidelines in accordance with the model created by the NAM Clinical 
Practice Guidelines We Can Trust. The American College of Obstetricians 
and Gynecologists was awarded the cooperative agreement and formed an 
expert panel called the Women's Preventive Services Initiative.
    Under section 2713 of the Public Health Service Act, non-
grandfathered group health plans and issuers of non-grandfathered group 
and individual health insurance coverage are required to cover 
specified preventive services without a copayment, coinsurance, 
deductible, or other cost sharing, including preventive care and 
screenings for women as provided for in comprehensive guidelines 
supported by HRSA for this purpose. Non-grandfathered group health 
plans and health insurance issuers offering non-grandfathered group or 
individual coverage (generally, plans or policies created or sold after 
March 23, 2010, or older plans or policies that have been changed in 
certain ways since that date) are required to provide coverage without 
cost sharing for preventive services listed in the updated HRSA-
supported guidelines (which include the nine preventive services set 
out in the 2016 update, as well as the two services added in this 
update) beginning with the first plan year (in the individual market, 
policy year) that begins on or after December 29, 2018.

    Dated: February 20, 2018.
George Sigounas,
Administrator.
[FR Doc. 2018-03840 Filed 2-26-18; 8:45 am]
 BILLING CODE 4165-15-P