Notice2022-00465
Update to the Women's Preventive Services Guidelines
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
January 12, 2022
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
On December 30, 2021, HRSA approved updates to the HRSA- supported Women's Preventive Services Guidelines (Guidelines) that address health needs specific to women. The Guidelines are based on clinical recommendations from the Women's Preventive Services Initiative (WPSI), a coalition of experts and health professional organizations convened by the American College of Obstetricians and Gynecologist (ACOG) under a cooperative agreement awarded by HRSA. Under the Public Health Service Act and pertinent regulations, preventive care and screenings for women provided for in comprehensive guidelines supported by HRSA are required to be covered without cost sharing by group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage. This 2021 update adds one additional service, Preventing Obesity in Midlife Women, and revises five services: Breastfeeding Services and Supplies, Contraception, Screening for Human Immunodeficiency Virus Infection, Counseling for Sexually Transmitted Infections, and Well-Woman Preventive Visits. This notice serves as an announcement of the decision to update the Guidelines as further described below. Please see https://www.hrsa.gov/womens-guidelines/index.html for additional information.
Full Text
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<title>Federal Register, Volume 87 Issue 8 (Wednesday, January 12, 2022)</title>
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[Federal Register Volume 87, Number 8 (Wednesday, January 12, 2022)]
[Notices]
[Pages 1763-1764]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-00465]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Update to the 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: On December 30, 2021, HRSA approved updates to the HRSA-
supported Women's Preventive Services Guidelines (Guidelines) that
address health needs specific to women. The Guidelines are based on
clinical recommendations from the Women's Preventive Services
Initiative (WPSI), a coalition of experts and health professional
organizations convened by the American College of Obstetricians and
Gynecologist (ACOG) under a cooperative agreement awarded by HRSA.
Under the Public Health Service Act and pertinent regulations,
preventive care and screenings for women provided for in comprehensive
guidelines supported by HRSA are required to be covered without cost
sharing by group health plans and health insurance issuers offering
non-grandfathered group or individual health insurance coverage. This
2021 update adds one additional service, Preventing Obesity in Midlife
Women, and revises five services: Breastfeeding Services and Supplies,
Contraception, Screening for Human Immunodeficiency Virus Infection,
Counseling for Sexually Transmitted Infections, and Well-Woman
Preventive Visits. This notice serves as an announcement of the
decision to update the Guidelines as further described below. Please
see <a href="https://www.hrsa.gov/womens-guidelines/index.html">https://www.hrsa.gov/womens-guidelines/index.html</a> for additional
information.
FOR FURTHER INFORMATION CONTACT: Kimberly Sherman, HRSA, Maternal and
Child Health Bureau, telephone (301) 443-8283, email:
<a href="/cdn-cgi/l/email-protection#7304161f1f041c1e121d10120116331b0100125d141c05"><span class="__cf_email__" data-cfemail="acdbc9c0c0dbc3c1cdc2cfcddec9ecc4dedfcd82cbc3da">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: The updated 2021 HRSA-supported Women's
Preventive Services Guidelines, along with information related to their
development and implementation, are available at <a href="https://www.hrsa.gov/womens-guidelines/index.html">https://www.hrsa.gov/womens-guidelines/index.html</a>. A summary of information regarding the
updates to the comprehensive guidelines supported by HRSA on December
30, 2021, is set out below.
Women's Preventive Services Guidelines
The first HRSA-supported Guidelines, based on recommendations of
the Institute of Medicine, were established in 2011. The Guidelines
were subsequently updated following review and recommendations by the
ACOG under the WPSI cooperative agreement, awarded by HRSA in 2016. The
purpose of WPSI is to improve adult women's health across the lifespan
by engaging a coalition of experts and health professional
organizations to recommend updates to the HRSA-supported Guidelines.
Following such review and recommendations, HRSA decides whether or not
to support, in whole or in part, the recommended updates to the
Guidelines. In March 2021, HRSA awarded a subsequent cooperative
agreement to ACOG to provide recommendations as appropriate over a 5-
year period to update the HRSA-supported Guidelines. Under the
cooperative agreement, ACOG, through the WPSI, engages in a process to
consider and review new and existing Guidelines developed by a
multidisciplinary group of women's health experts and professional
organizations.
Under section 2713 of the Public Health Service Act, 42 U.S.C.
300gg-13, group health plans and issuers of non-grandfathered group and
individual
[[Page 1764]]
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.
Private health insurance companies must provide this coverage without
cost-sharing in plan years (in the individual market, policy years)
beginning on or after the date that is one year after the date the
recommendation or guideline is issued. A change to the Guidelines is
considered to be issued on the date on which it is accepted by the HRSA
Administrator.
Summary of the 2021 Updates Recommended by WPSI and Approved by HRSA
Breastfeeding Services and Supplies
WPSI recommends comprehensive lactation support services (including
consultation, counseling, education by clinicians and peer support
services, and breastfeeding equipment and supplies) during the
antenatal, perinatal, and postpartum periods to optimize the successful
initiation and maintenance of breastfeeding.
Breastfeeding equipment and supplies include, but are not limited
to, double electric breast pumps (including pump parts and maintenance)
and breast milk storage supplies. Access to double electric pumps
should be a priority to optimize breastfeeding and should not be
predicated on prior failure of a manual pump. Breastfeeding equipment
may also include equipment and supplies as clinically indicated to
support dyads with breastfeeding difficulties and those who need
additional services.
Contraception
WPSI recommends that adolescent and adult women have access to the
full range of contraceptives and contraceptive care to prevent
unintended pregnancies and improve health outcomes. Contraceptive care
includes screening, education, counseling, and provision of
contraceptives (including in the immediate postpartum period).
Contraceptive care also includes follow-up care (e.g., management,
evaluation, and changes, including the removal, continuation, and
discontinuation of contraceptives).
WPSI recommends that the full range of U.S. Food and Drug
Administration (FDA)-approved, -granted, or -cleared contraceptives,
effective family planning practices, and sterilization procedures be
available as part of contraceptive care. The full range of
contraceptives currently includes those listed in the FDA's Birth
Control Guide: \1\ (1) Sterilization surgery for women, (2) implantable
rods, (3) copper intrauterine devices, (4) intrauterine devices with
progestin (all durations and doses), (5) injectable contraceptives, (6)
oral contraceptives (combined pill), (7) oral contraceptives (progestin
only), (8) oral contraceptives (extended or continuous use), (9) the
contraceptive patch, (10) vaginal contraceptive rings, (11) diaphragms,
(12) contraceptive sponges, (13) cervical caps, (14) condoms, (15)
spermicides, (16) emergency contraception (levonorgestrel), and (17)
emergency contraception (ulipristal acetate); and any additional
contraceptives approved, granted, or cleared by the FDA.
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\1\ This refers to FDA's Birth Control Guide (<a href="https://www.fda.gov/media/150299/download">https://www.fda.gov/media/150299/download</a>) as posted on December 22, 2021
with the exception of sterilization surgery for men, which is beyond
the scope of the WPSI.
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Screening for HIV Infection
WPSI recommends all adolescent and adult women, ages 15 and older,
receive a screening test for human immunodeficiency virus (HIV) at
least once during their lifetime. Earlier or additional screening
should be based on risk, and rescreening annually or more often may be
appropriate beginning at age 13 for adolescent and adult women with an
increased risk of HIV infection.
WPSI recommends risk assessment and prevention education for HIV
infection beginning at age 13 and continuing as determined by risk.
A screening test for HIV is recommended for all pregnant women upon
initiation of prenatal care with rescreening during pregnancy based on
risk factors. Rapid HIV testing is recommended for pregnant women who
present in labor with an undocumented HIV status.
Counseling for Sexually Transmitted Infections
WPSI recommends behavioral counseling by a health care clinician or
other appropriately trained individual for sexually active adolescent
and adult women at an increased risk for sexually transmitted
infections (STIs).
WPSI recommends that clinicians review a woman's sexual history and
risk factors to identify those at increased risk for STIs. Risk factors
include, but are not limited to, age younger than 25 years, a recent
history of an STI, a new sex partner, multiple partners, a partner with
concurrent partners, a partner with an STI, and a lack of or
inconsistent condom use. For those without identified risk factors,
counseling to reduce the risk of STIs should be considered on an
individual basis as determined by clinical judgment.
Well-Woman Preventive Visits
WPSI recommends that women receive at least one preventive care
visit per year beginning in adolescence and continuing across the
lifespan to ensure the provision of all recommended preventive
services. The primary purpose of well-woman visits is the delivery and
coordination of recommended preventive services as determined by age
and risk factors. These services may be completed at a single visit or
as part of a series of visits that take place over time to obtain all
necessary services depending on a woman's age, health status,
reproductive health needs, pregnancy status, and risk factors. Well-
women visits also include pre-pregnancy, prenatal, postpartum, and
interpregnancy visits.
Preventing Obesity in Midlife Women
WPSI recommends counseling midlife women aged 40 to 60 years with
normal or overweight body mass index (BMI) (18.5-29.9 kg/m2) to
maintain weight or limit weight gain to prevent obesity. Counseling may
include individualized discussion of healthy eating and physical
activity.
Diana Espinosa,
Acting Administrator.
[FR Doc. 2022-00465 Filed 1-11-22; 8:45 am]
BILLING CODE 4165-15-P
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