Notice2022-28661
Update to the Bright Futures Periodicity Schedule as Part of the HRSA-Supported Preventive Services Guidelines for Infants, Children, and Adolescents
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Published
January 5, 2023
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
A Federal Register notice published on November 2, 2022, detailed and sought public comment on recommendations under development by the Bright Futures Pediatric Implementation Program (Bright Futures Program), regarding updates to the HRSA-supported preventive services guidelines for infants, children, and adolescents in the Bright Futures Periodicity Schedule. The proposed updates are specifically related to increasing the upper age limit for Human Immunodeficiency Virus (HIV) screening. The Bright Futures Program convenes health professionals to develop draft recommendations for HRSA's consideration. Ten comments were received and considered as detailed below. On December 30, 2022, HRSA accepted as final the Bright Future Program's recommended update to the HIV screening guideline. Under applicable law, non-grandfathered group health plans and health insurance issuers offering non- grandfathered group and individual health insurance coverage must include coverage, without cost sharing, for certain preventive services, including those provided for in the HRSA-supported preventive services guidelines for infants, children, and adolescents. The Departments of Labor, Health and Human Services, and the Treasury have previously issued regulations, which describe how group health plans and health insurance issuers apply the coverage requirements. Please see https://mchb.hrsa.gov/programs-impact/bright-futures for additional information.
Full Text
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<title>Federal Register, Volume 88 Issue 3 (Thursday, January 5, 2023)</title>
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[Federal Register Volume 88, Number 3 (Thursday, January 5, 2023)]
[Notices]
[Pages 873-874]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-28661]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Update to the Bright Futures Periodicity Schedule as Part of the
HRSA-Supported Preventive Services Guidelines for Infants, Children,
and Adolescents
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services.
ACTION: Notice.
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SUMMARY: A Federal Register notice published on November 2, 2022,
detailed and sought public comment on recommendations under development
by the Bright Futures Pediatric Implementation Program (Bright Futures
Program), regarding updates to the HRSA-supported preventive services
guidelines for infants, children, and adolescents in the Bright Futures
Periodicity Schedule. The proposed updates are specifically related to
increasing the upper age limit for Human Immunodeficiency Virus (HIV)
screening. The Bright Futures Program convenes health professionals to
develop draft recommendations for HRSA's consideration. Ten comments
were received and considered as detailed below. On December 30, 2022,
HRSA accepted as final the Bright Future Program's recommended update
to the HIV screening guideline. Under applicable law, non-grandfathered
group health plans and health insurance issuers offering non-
grandfathered group and individual health insurance coverage must
include coverage, without cost sharing, for certain preventive
services, including those provided for in the HRSA-supported preventive
services guidelines for infants, children, and adolescents. The
Departments of Labor, Health and Human Services, and the Treasury have
previously issued regulations, which describe how group health plans
and health insurance issuers apply the coverage requirements. Please
see <a href="https://mchb.hrsa.gov/programs-impact/bright-futures">https://mchb.hrsa.gov/programs-impact/bright-futures</a> for additional
information.
FOR FURTHER INFORMATION CONTACT: Bethany Miller, HRSA, Maternal and
Child Health Bureau, telephone: (301) 945-5156, email:
<a href="/cdn-cgi/l/email-protection#87c5caeeebebe2f5c7eff5f4e6a9e0e8f1"><span class="__cf_email__" data-cfemail="ecaea1858080899eac849e9f8dc28b839a">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: Under the Patient Protection and Affordable
Care Act, Public Law 111-148, the preventive care and screenings set
forth in HRSA-supported guidelines are required to be covered without
cost-sharing by certain group health plans and health insurance
issuers. The Department adopted the Bright Futures Periodicity Schedule
as a HRSA-supported guideline for infants, children, and adolescents
under section 2713 of the Public Health Service Act. See 75 FR 41726,
41740 (July 19, 2010). To develop recommendations for HRSA's
consideration, the Bright Futures Program convenes a panel of pediatric
primary care experts to conduct rigorous reviews of current scientific
evidence, solicit and consider public input, and make recommendations
to HRSA regarding screenings and assessments recommended at each well-
child visit from infancy through adolescence. HRSA then determines
whether to support, in whole or in part, the recommended updates. The
schedule of preventive care and screenings for infants, children, and
adolescents is reflected in the Bright Futures Periodicity Schedule.
This work is supported through the Bright Futures Program via
cooperative agreement with the American Academy of Pediatrics.
The Bright Futures Program convenes a panel of pediatric primary
care experts that examines the evidence to develop new (and update
existing) recommendations for pediatric preventive services. The Bright
Futures Program also disseminates final HRSA-supported recommendations
through the annual publication of the updated Bright Futures
Periodicity Schedule, with associated resources for practitioners and
families.
The Bright Futures Program bases its recommended updates to the
Guidelines on review and synthesis of existing clinical guidelines and
new scientific evidence. Additionally, HRSA requires that the Bright
Futures Program incorporate processes to assure opportunity for public
comment in the development of the updated Bright Futures Periodicity
Schedule.
The Bright Futures Program proposed and HRSA has accepted
recommended updates to the Bright Futures Periodicity Schedule relating
to increasing the upper age limit for Screening for HIV as detailed
below.
Screening for HIV
In the current Bright Futures Periodicity Schedule, the age range
recommended for adolescent universal screening for HIV is between the
15-year visit and 18-year visit. The Bright Futures Program proposed
and HRSA has accepted an update that would expand the recommended age
range for adolescent universal screening for HIV to between the 15-year
visit and 21-year visit.
In the Bright Futures Periodicity Schedule, a ``dot'' with an
``arrow'' indicates a ``range during which a service may be provided.''
The previous guideline and updated guideline on HIV screening is
reflected in the chart below:
[GRAPHIC] [TIFF OMITTED] TN05JA23.006
All such screenings (universal and risk-based) within this age
range are within the scope of the guideline. The update also includes
an accompanying footnote to provide updated information about more
frequent screening for youth assessed as at high risk of HIV infection.
The full footnote reads: ``Screen adolescents for HIV at least once
between the ages of 15 and 21 making every effort to preserve
confidentiality of the adolescent, as per ``Human
[[Page 874]]
Immunodeficiency Virus (HIV) Infection: Screening'' (<a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening">https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening</a>), and after initial
screening, youth at increased risk of HIV infection should be retested
annually or more frequently, as per ``Adolescents and Young Adults: The
Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV
Prophylaxis'' (<a href="https://doi.org/10.1542/peds.2021-055207">https://doi.org/10.1542/peds.2021-055207</a>).
Discussion of Recommended Updated Guidelines
Early detection of an infection with HIV in adolescents and young
adults can lead to improved health outcomes and reduce the further
spread of HIV by individuals who are not yet aware they are infected.
Universal screening is a type of screening that a provider may
recommend without first identifying a specific risk factor or symptom.
Given the sustained high numbers of people living with HIV in the
United States; documented missed opportunities for HIV testing;
advances in HIV diagnostics, treatment, and prevention; and age
stratified epidemiological data around HIV incidence and HIV risk
related behaviors, the range for universal screening is being extended
to the 21-year visit.<SUP>1 2</SUP> The aim is to better detect, treat,
support, and prevent HIV infection among adolescents and youth, as well
as the population at large.
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\1\ Hsu KKC, Rakhmanina NY, Chadwick EG. et al. Adolescents and
young adults: the pediatrician's role in HIV testing and pre- and
postexposure HIV prophylaxis. Pediatrics 2022; 149 (01) e2021055207.
\2\ US Preventive Services Task Force Final Recommendation
Statement: Human Immunodeficiency Virus (HIV) Infection: Screening.
2019. Available at: <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening">https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening</a>.
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A Federal Register notice on November 2, 2022 sought public comment
on these proposed updates (87 FR 66197).\3\ The Bright Futures Program
considered all public comments as part of its deliberative process and
provided the comments to HRSA for its consideration. A total of 10
responders provided comments, the majority of whom agreed with the
proposed update. Two respondents provided additional views. One comment
suggested lowering the screening age range. Current clinical guidance
to begin universal screening at age 15 is based on the age-stratified
incidence of HIV infection and data on sexual activity in youth. No
changes were made in response to this comment. The other comment did
not specifically address HIV screening and is therefore beyond the
scope of the proposed update.
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\3\ See <a href="https://www.federalregister.gov/documents/2022/11/02/2022-23845/notice-of-request-for-public-comment-on-proposed-update-to-the-bright-futures-periodicity-schedule">https://www.federalregister.gov/documents/2022/11/02/2022-23845/notice-of-request-for-public-comment-on-proposed-update-to-the-bright-futures-periodicity-schedule</a>.
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After consideration of public comment, the Bright Futures Program
submitted recommended updates for HIV screening to HRSA for
consideration, as detailed above. On December 30, 2022, the HRSA
Administrator accepted the Bright Futures Program recommendations and,
as such, updated the guidelines. Non-grandfathered group health plans
and health insurance issuers offering group or individual health
insurance coverage must cover without cost-sharing the services and
screenings listed as the HRSA-supported preventive services guidelines
for infants, children, and adolescents for plan years (in the
individual market, policy years) that begin one year after this date.
Thus, for most plans, this update will take effect for purposes of the
Section 2713 coverage requirement in 2024. Additional information
regarding the Bright Futures Program can be accessed at the following
link: <a href="https://mchb.hrsa.gov/maternal-child-health-topics/child-health/bright-futures.html">https://mchb.hrsa.gov/maternal-child-health-topics/child-health/bright-futures.html</a>.
Authority: Section 2713(a)(4) of the Public Health Service Act, 42
U.S.C. 300gg-13(a)(4).
Carole Johnson,
Administrator.
[FR Doc. 2022-28661 Filed 1-4-23; 8:45 am]
BILLING CODE 4165-15-P
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