ACA Now

Implementation Status

An inventory of regulations and guidance – including rules issued by HHS, Treasury and DOL – related to the implementation of ACA first-dollar preventive coverage requirements is available on the CCIIO website. On December 28, 2010, HHS, Treasury and DOL issued a Request for Information regarding value-based insurance design in connection with preventive care benefits.

HHS fact sheets relevant to this section are accessible here.

More information on the U.S. Preventive Services Task Force, on whose recommendations this section’s first-dollar coverage requirements rely, is available here; in particular, see the USPSTF ACA homepage for “A” and “B” rated services. More information on HRSA-supported women’s preventive services guidelines is available here. Also see the CDC Advisory Committee on Immunization Practices’ (ACIP) website.

2013

On February 1, 2013, HHS and the Departments of Treasury and Labor issued a proposed regulation requiring non-exempt, non-grandfathered group health plans provide coverage, without cost-sharing, of certain preventive health services, including contraceptive services. The rule purported to accommodate religious organizations by allowing them to afford employees access to separate coverage to contraceptive services without any cost to the organization. Comments on the regulation are due by April 8, 2013.

On February 20-21, 2013, the CDC’s ACIP will meet to discuss the Vaccines for Children immunization recommendations adopted by the CDC. These recommendations must be covered by applicable health plans. Details are available here.

On February 20, 2013, CMS issued an FAQ addressing limitations on cost-sharing under the ACA and coverage of preventive services.

On March 18, 2013, HHS issued a press release in conjunction with a report finding that 71 million privately insured individuals had received at least one preventive service in 2011 and 2012 without incurring cost sharing as a result of ACA first-dollar coverage provisions for these services.

In a development that implicates this section, on June 25, the U.S. Preventive Services Task Force (USPSTF) issued its final (“Grade B”) recommendation in which it recommends screening for hepatitis C virus infection in persons at high risk for infection. The USPSTF also recommends offering one-time screening for HCV infection to adults born between 1945 and 1965.  This means that most insurers will be required to cover the screening at no cost to their enrollees. For more information about the recommendation, including the evidence assessed to make this determination as well as a consumer fact sheet, please see here.

On July 2, HHS, DOL and Treasury published in the Federal Register a final rule that, according to the Administration, is designed to “simplify and clarify the religious employer exemption” to providing contraceptive services coverage under broader ACA first-dollar women’s preventive services coverage requirements, among other related provisions. HHS issued a news release and an updated fact sheet on women’s preventive services. Also see a CCIIO fact sheet. CMS also issued technical guidance regarding a temporary enforcement safe harbor of the contraceptive coverage requirement; and a self-certification form (listed under the release date June 28, 2013 for use for plan years beginning on or after January 1, 2014) for eligible organizations “to be executed by an organization seeking to be treated as an eligible organization for purposes of an accommodation under these final regulations.” HRSA updated its women’s preventive services guidelines, adding a note to reflect the final rule’s provisions and effective dates.

On July 29, CMS issued a press release noting that in the first six months of 2013, 16.5 million Medicare fee-for-service beneficiaries had received at least one preventive service that was covered without cost-sharing because of ACA provisions under this section. CMS’s press release is available here.

Additionally, in a development that implicates this section, on July 30, the U.S. Preventive Services Task Force (USPSTF) announced a draft recommendation statement pertaining to low-dose CT for lung cancer screening in high-risk patients based on age and smoking status with a draft recommendation of “B.” Comments are due by August 26, 2013.

On August 26, the U.S. Preventive Services Task Force gave a “B” grade (see a press release and clinical summary) to primary care interventions – including education or brief counseling – on tobacco-use prevention among children and adolescents. The recommendation will have implications for ACA first-dollar coverage requirements among certain individual and group health plans.

On August 16, CMS published a proposed information collection and comment request (see#3 on p. 2 of the PDF), “Data Submission for the Federally-facilitated Exchange (FFE) User Fee Adjustment.” It relates to accommodations for self-certifying entities relative to otherwise-applicable requirements to provide first-dollar contraceptive services and the insurer and third-party administrator information collections that underlie the “processes and standards to fund the payments for the contraceptive services that are provided for participants and beneficiaries in self-insured plans of eligible organizations under the accommodation…through an adjustment in the Federally-facilitated Exchange (FFE) user fee payable by an issuer participating in an FFE.”  See the applicable documentation in CMS’s Paperwork Reduction Act package. Comments are due on October 15.

In a related development, reinforcing and updating a 2002 recommendation (see a release), in September 2013 the USPSTF gave a “B” rating to using medications – tamoxifen or raloxifene – for reducing the risk of primary breast cancer in women age 35 and older at increased risk who do not have a high probability of adverse events, noting clinicians should engage patients in shared decision-making. In August, HHS’s Assistant Secretary for Planning and Evaluation published a report on screening for domestic violence in health settings—a clinical preventive service that, specifically relative to intimate partner “B” rating earlier this year (see a release).

On September 10, the IRS posted a Notice, “Preventive health services required under Public Health Service Act section 2713 and preventive care for purposes of Health Savings Accounts.” In it, the IRS clarifies that a high-deductible health plan will not lose such status under the Internal Revenue Code “merely because it provides without a deductible the preventive health services required under section 2713 of the Public Health Service Act (PHS Act) to be provided by a group health plan or a health insurance issuer offering group or individual health insurance coverage.”

On September 13, the DOL issued a Technical Release providing guidance on the application of certain ACA market reforms – specifically, limitations on annual dollar limits and preventive services requirements – to health reimbursement arrangements, employer payment plans, health FSAs and employee assistance programs. Concurrently, the IRS released Notice 2013-54 largely tracking DOL’s Technical Release. On September 16, CCIIO posted a bulletin concurring with DOL and IRS guidance insofar as it pertains to HHS oversight.

On Nov. 7, in a related development, the U.S. Preventive Services Task Force (USPSTF) released its third annual report to Congress emphasizing evidence gaps relating to older adults’ preventive care, including screening for cognitive impairment and dementia, as well as preventing falls and fractures. On Nov. 14, the USPSTF released for public comment its draft research plan (also see Q&As) for breast cancer screening through Dec. 11.

On Dec. 17, CMS issued a release with new state-by-state data (available here) indicating that, due to ACA provisions, more than 25.4 million Medicare fee-for-service (FFS) beneficiaries received at least one or more preventive benefits at no out-of-pocket cost in 2013 (Jan.-Nov.), slightly above the 2012 figure of 24.7 million individuals. In a related development, on Jan. 21, Sens. Tom Coburn (R-OK), joined by several other Republican colleagues, wrote a letter to HHS expressing concern about the agency’s suggestion that such benefits are “free.”

On Dec. 24, the USPSTF issued (consumer fact sheet; clinical summary) a “B” grade recommending that women be screened with one of several risk assessment tools if their family members have breast, ovarian, tubal or peritoneal cancer in order “to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2)” and, if such risk stratification results are positive, that they “should receive genetic counseling and, if indicated after counseling, BRCA testing.” The USPSTF found insufficient evidence to recommend that genetic testing or counseling routinely be performed among women whose family history is not linked to an increased risk for the mutations.

On Dec. 31, the USPSTF issued (consumer fact sheet; clinical summary) a final “B” grade for annual low-dose CT lung cancer screening for high-risk patients ages 55-80 with a “30 pack-year smoking history,” including current smokers and those who have quit within 15 years. (On Jan. 13, USPSTF issued a fact sheet on engaging patients on the recommendation.)

2014

On Jan. 14, the USPSTF recommended, with a “B” grade, screening asymptomatic pregnant women for gestational diabetes mellitus after 24 weeks of gestation, but gave an inconclusive “I” rating to such screening before 24 weeks (consumer fact sheet; clinical summary; press release).

On Jan. 24, the U.S. Supreme Court issued an order in a pending case stipulating that the Little Sisters of the Poor will not have to comply with ACA conception coverage requirements while they challenge the law.

On Jan. 27, revisiting a 2005 recommendation, the USPSTF reaffirmed its “B” statement for one-time, ultrasonography-based abdominal aortic aneurysm screening among men ages 65-75 who ever were smokers. The USPSTF noted that compared with its 2005 statement, the draft statement “differs in that instead of one D recommendation for screening for AAA in all women, the USPSTF now has two separate recommendations: an I statement for women who have ever smoked and a D recommendation for women who have never smoked.” Comments are being accepted until Feb. 24, 2014.

On Jan. 9, in a wide-ranging set of FAQs, DOL, HHS and Treasury stipulate that non-grandfathered plans cover breast cancer chemo prevention drugs on a first-dollar basis for specified women at increased risk, as recently recommended by the USPSTF, for plan or policy years after Sept. 24, 2014; and clarify that ACA out-of-pocket maximums apply in 2015 across all essential health benefits (EHBs), despite a 2014 transitional policy that allowed some plans with separate prescription drug or pediatric dental benefit administrators, for example, to apply separate OOP maximums to such benefits. Additional FAQs address expatriate health plans, wellness programs and the ACA’s effect on mental health parity in the individual and small group markets.

On Feb. 11, the U.S. Preventive Services Task Force issued a draft recommendation would carry a “B” rating for hepatitis B screening in high-risk patients (see bulletin for details). Comments are due by March 10, 2014.

On Feb. 18, the USPSTF posted a draft evidence report and recommendation statement, with a “D” rating for screening for asymptomatic carotid artery stenosis. Both are available for public comment through March 17, 2014.

On Feb. 24, in a related development, the USPSTF issued a final recommendation statement concluding there is “not enough evidence to determine the effectiveness of taking vitamins and minerals to prevent cardiovascular disease or cancer.” Detailed materials are posted here.

On March 27, USPSTF issued for public comment a draft research plan on primary care screening for depression in adults. Comments are due by April 23, 2014. On March 25, the Supreme Court heard cases involving Hobby Lobby’s (docket) and Conestoga Wood Specialties’ (docket) challenges to the ACA contraceptive coverage mandate.On March 25, in a final recommendation statement (materials; release), the USPSTF finds insufficient evidence to recommend screening those older than age 65 for cognitive impairment if they do not have signs or symptoms. On March 19, the U.S. Preventive Services Task Force announced its appointment of a new chair and co-vice chair. On March 11, AHRQ issued a notice soliciting nominees to serve on the USPSTF. Nominations are due by May 15 to be considered for appointment beginning January 2015. Also on March 11, the USPSTF issued (details) a final “I” rating, finding insufficient evidence for primary care behavioral interventions to reduce illicit drug and non-medical pharmaceutical use among children and adolescents. The recommendation does not include those with a diagnosed substance abuse disorder.

On April 29, in a draft recommendation statement, the U.S. Preventive Services Task Force (USPSTF) reaffirms its 2008 “B” rating for intensive behavioral counseling to prevent sexually transmitted diseases among sexually active adolescents and adults at increased risk. Comments are due by May 26, 2014. Also see an accompanying fact sheet and draft evidence report, the latter of which also is open for comment through May 26. Also on April 29, combining and streamlining past recommendations, a draft USPSTF recommendation (“B” rating) suggests chlamydia and gonorrhea screening in sexually active women ages 24 and younger and in older women at increased risk. It concludes that “current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.” Comments on the draft recommendation and a draft evidence report are being accepted until May 26, 2014.

On April 17, the USPSTF posted a final research plan on screening for colorectal cancer that will guide an Evidence-based Practice Center review and, ultimately, an updated recommendation on the service. On April 7, the USPSTF issued a draft recommendation giving a “B” grade for low-dose aspirin for high-risk women after 12 weeks’ gestation, noting the potential to reduce morbidity and mortality from preeclampsia. Comments are due by May 5, 2014. 

On April 3, the USPSTF released a draft research plan, Screening for Impaired Visual Acuity in Older Adults, that was open for comment through April 30, 2014.

On May 13, 2014 the IRS said in a Q&A that employers cannot give employees tax-free payments for inside or outside of Marketplace plans because such arrangements (employer payment plans) are considered group plans and must comply with certain Affordable Care Act (ACA) reforms, including the ban on annual limits for essential health benefits, as well as preventive services coverage requirements. The IRS says such arrangements “cannot be integrated with individual policies to satisfy the market reforms” and that employers would be subject to excise taxes of $100/day per employee ($36,500/year). Further details are available in a September 2013 notice.

On May 26, the U.S. Preventive Services Task Force (USPSTF) released a final “B” rating for screening high-risk individuals, including adults and adolescents who have not been vaccinated and are not pregnant, for hepatitis B.

On May 15, the USPSTF posted a draft research plan on skin cancer screening; comments are due by June 11, 2014.

On May 13, the USPSTF issued a draft “B” grade recommendation, open for comment to June 9, 2014, calling for behavioral counseling to prevent cardiovascular disease in certain overweight or obese adults.

On May 5, the USPSTF posted a final research plan, Screening for Dyslipidemia and Use of Statins to Improve Cardiovascular Outcomes in Adults, that an Evidence-based Practice Center will use to inform a systematic evidence review, ultimately guiding an updated preventive recommendation on the topic.

Also on May 5, the USPSTF gave a “B” rating to primary care clinicians prescribing oral fluoride supplementation to children age 6 months and above “whose water supply is deficient in fluoride.” An accompanying “B” rating recommends fluoride for infants’ and children’s primary teeth, starting with primary tooth eruption. However, the USPSTF finds insufficient evidence to recommend routine screening by primary care clinicians for dental caries from birth to age 5. Also see a consumer fact sheet.

On May 2, the DOL issued Model COBRA notices and FAQs; the notices reflect possible Marketplace coverage options. FAQs also address approaches to including out-of-network providers’ balance-billed amounts toward out-of-pocket maximums (if plans elect), reference pricing and other topics. Additional FAQs address preventive services coverage of tobacco interventions and summary of benefits and coverage requirements.

On May 29, the USPSTF finalized a research plan on the use of spirometry to screen for chronic obstructive pulmonary disease.

On June 24, HRSA posted a $500,000 grant opportunity for a public, private or community-based organization working to improve women’s health by increasing utilization of clinical preventive services.

On June 23, in a draft recommendation that is open for comment until July 21, 2014, the USPSTF indicates that “current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency.”

Also on June 23, the USPSTF changed its 2005 recommendation against screening certain female smokers or women who have ever smoked for abdominal aortic aneurysm to “I,” signifying insufficient evidence to “assess the balance of benefits and harms.” Also see a consumer fact sheet.

On June 13, the USPSTF issued a final research plan on screening older adults for impaired visual acuity that will lay the groundwork for an Evidence-based Practice Center systematic review and subsequent preventive service recommendation.

On June 5, the USPSTF issued a draft research plan addressing screening adults for latent tuberculosis infection on which comments are being accepted through July 2, 2014.

On June 26, the USPSTF issued a draft research plan on screening for syphilis infection in nonpregnant adolescents and adults and accepted comments through July 26. In a June 27 report (release), HHS highlighted preventive services coverage under the AC

On July 24, the U.S. Preventive Services Task Force (USPSTF) released a final research plan (details) on breast cancer screening that will guide a systematic evidence review, the next step in updating its preventive service recommendation on the topic. The last evidence review occurred in 2009.

On Feb. 26, DOL submitted a notice for OMB approval that would extend – without change – information collections underlying certain religious employers’ claiming of exemptions to ACA contraception coverage requirements. Comments are due in 30 days.

On Mar. 3, CMS posted a Paperwork Reduction Act package addressing employer notification to HHS of objections to providing first-dollar coverage for contraception. On Mar. 5, the U.S. Preventive Services Task Force (USPSTF) issued a final research plan on periodic screening with pelvic exams to detect gynecological conditions. On Mar. 24, in a final recommendation statement, the USPSTF found insufficient evidence on the benefits and harms of routinely screening asymptomatic, nonpregnant adults for thyroid dysfunction. On Mar. 26, the USPSTF posted a draft research plan on ovarian cancer screening, comments on which are due Apr. 22

On April 30, the USPSTF released a draft research plan on screening for genital herpes and accepted comments through May 27. Additionally:

On May 5, the USPSTF issued draft recommendations on asking adults and pregnant women about tobacco use and using pharmacologic and behavioral interventions among those using such products. It accepted comments on the recommendations and a draft evidence review through June 1.

On May 6, 62 bicameral Members urged HHS to oppose USPSTF draft recommendations on breast cancer screening in light of concerns they would make it more difficult for women ages 40-49 to receive first-dollar coverage.

On May 11, CCIIO, Treasury and DOL released guidance on ACA first-dollar coverage requirements for women’s preventive services. The guidance addresses non-grandfathered individual and group plans’ coverage of BRCA testing and counseling, FDA-approved contraceptives, sex-specific services, well-woman care for dependents and anesthesia care during preventive colonoscopy.

On May 14, USPSTF finalized a research plan that will guide an evidence review examining behavioral counseling on healthful diet and physical activity for cardiovascular disease prevention.

On May 14, HHS’ Assistant Secretary for Planning and Evaluation released a data point estimating that 137M individuals with private insurance have access to preventive services without cost sharing.

On May 20, DOL sent a final rule, “Summary of Benefits and Coverage and Uniform Glossary,” to OMB for regulatory clearance.

On June 11, the Administration launched the Healthy Self initiative, which promotes healthy lifestyles and seeks to connect the newly insured with recommended preventive services.

On June 18, the USPSTF issued a draft research plan on screening for osteoporosis; comments are due by July 15.

On June 25, USPSTF issued a draft research plan on menopausal hormone therapy for primary prevention of chronic conditions. It is available for review and public comment through July 22.

On June 24-25, the Advisory Committee on Immunization Practices convened in Atlanta.

On July 7, the USPSTF released a final recommendation statement on screening for speech and language delay and disorders in children ages 5 and younger.

On July 10, CMS issued a final rule (fact sheet; information collection details) in response to the Hobby Lobby decision that some for-profit businesses may be exempt from ACA contraceptive coverage requirement in the same way as nonprofit religious groups.

On July 21, in a draft recommendation statement, the USPSTF found evidence is insufficient to recommend routine screening for impaired visual acuity in older adults who present in primary care settings without vision problems. Comments are due by Aug. 17.

On July 27, the USPSTF issued a draft “B” rating for screening adults for depression. It updates a 2009 “B” rating by explicitly including pregnant and postpartum women and eliminating the recommendation that only selective screening be performed if staff-assisted depression care supports are not in place. Also see a draft evidence review. Comments are due by Aug. 24.

On Sept. 3, the USPSTF issued a final research plan on cardiovascular disease risk assessments using nontraditional risk factors.

On Sept. 8, the USPSTF issued a final recommendation statement on screening for iron deficiency anemia and iron supplementation in pregnant women as well as a parallel statement regarding screening for iron deficiency anemia in young children.

On Sept. 8, in an updated draft recommendation statement and draft evidence review, the USPSTF recommends (with a preliminary “B” grade) screening for major depressive disorder in adolescents ages 12 to 18 years when adequate systems are in place for diagnosis, treatment, and monitoring. However, the USPSTF’s review of the evidence was “insufficient” for it to render a comparable draft recommendation for the age 11 years and younger cohort. Furthermore, the USPSTF’s updated draft recommendation reaffirms its 2009 recommendation for the adolescent (ages 12 to 18 years) population “but removes the mention of specific therapies in recognition of decreased concern over the harms of pharmacotherapy in adolescents when patients are adequately monitored.”  Comments on the draft recommendation and draft evidence review are due by 8 p.m. ET on Oct. 5.

On Sept. 15, in a draft statement, the USPSTF recommended low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer in adults ages 50 to 59 years who have “a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.” Comments are due by Oct. 12.

On Sept. 22, the USPSTF gave a final “A” rating for clinicians asking non-pregnant adults about tobacco use, advising them to quit and providing behavioral interventions and FDA-approved cessation drugs. The Task Force also gave an “A” to those interventions in pregnant women, without the inclusion of cessation drugs, adding that “current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women.” The Task Force added that evidence is insufficient to recommend electronic nicotine delivery systems for cessation in adults, including those who are pregnant.

On Sept. 24, the USPSTF issued a draft research plan on screening for pediatric visual impairment.

On Oct. 6, the USPSTF released a draft recommendation statement reaffirming its 2008 recommendation to screen adults ages 50-75 for colorectal cancer (“A” rating). The draft indicates that the decision to screen among those ages 76-85 be an individualized decision that accounts for patients’ overall health and prior screening history (“C” rating). Comments are due by Nov. 2.

On Oct. 13, the USPSTF recommended screening for high blood pressure in adults ages 18 years or older. The USPSTF recommended obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.

On Oct. 27, the USPSTF recommended screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese.

On Oct. 29, the USPSTF sought comments (due: Nov. 25) on a draft research plan on prostate cancer screening.

On Oct 29, the USPSTF issued a final research plan on cervical cancer screening.

On Dec. 1, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation statement finding insufficient evidence to assess the benefits and harms of visual skin cancer screening in adults. Comments were due by Dec. 28.

On Dec. 10, the USPSTF posted a draft research plan on behavioral and pharmacotherapy interventions for weight loss to prevent obesity-related morbidity and mortality in adults. Comments were due by Jan. 13.

On Dec. 15, echoing and updating its 2004 recommendation, the USPSTF issued a draft “A” rating for screening non-pregnant adults and adolescents who are at increased risk for syphilis infection. Comments were due by Jan. 18.

On Dec. 17, the USPSTF finalized a research plan on vision screening among pediatric patients (ages six months to five years).

On Dec. 21, the USPSTF issued draft recommendations on screening children and adolescents for lipid disorders (“I” grade for insufficient evidence; here) and treating certain adults ages 40-75 with statins for primary prevention of cardiovascular in specified cases (“B” grade; here), among other recommendations. Comments were due by Jan. 25, 2016.

2016

On Jan. 7, 2016, the USPSTF finalized a research plan that will inform a systematic evidence review on screening adolescents for idiopathic scoliosis.

On Jan. 12, the USPSTF issued its final recommendation on screening for breast cancer, saying mammography is most beneficial between ages 50 and 74. See here for a Task Force editorial about the release.

On Jan. 26, the USPSTF finalized its draft update to adult depression screening recommendations, including the addition of pregnant and post-partum women to the “B”-rated service.

On Feb. 9, the USPSTF issued a final recommendation statement in which screening for major depressive disorder (MDD) in adolescents – ages 12 to 18 years – received a “B” grade. The Task Force did not reach a conclusion for screening children ages 11 and younger.

On Feb. 16, in a final “I” statement, the USPSTF finds insufficient evidence to assess the balance of benefits and risks of screening children ages 18-30 months for autism spectrum disorder. The Task Force says the statement is not a recommendation against such screening. Also see a video explanation and FAQs.

On Feb. 24, the Advisory Committee on Immunization Practices convened, as announced in a Federal Register notice.

On Mar. 31, the USPSTF posted a draft research plan on vitamin D, calcium, or combined supplementation for the primary prevention of fractures in adults. The comment period ended on Apr. 27, 2016.

On Mar. 31, USPSTF issued the final research plan for behavioral and pharmacotherapy interventions for weight loss to prevent obesity-related morbidity and mortality.

On Apr. 4, the Agency for Healthcare Research and Quality (AHRQ) issued a call-for-nominations for the USPSTF. Nominations are due by May 15, 2016.

On Apr. 6, the USPSTF issued a final recommendation statement on screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults. Reinforcing its August 2015 draft recommendation, the Task Force recommended against screening for COPD in asymptomatic adults, with a “D” rating.

On Apr. 12, the USPSTF released a final recommendation statement on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer.

On Apr. 20, HHS, DOL, and the Treasury issued joint FAQs regarding implementation of ACA market reform provisions, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Specific market reforms made by the ACA, including emergency services protections, coverage of preventive services, prohibition on rescissions, coverage of individuals participating in approved clinical trials, and limitations on cost sharing, are all addressed.

On Apr. 25, CMS released an extensive final rule on Medicaid and CHIP managed care (press release; add’l fact sheets available here under “final rule”) that seeks to acknowledge increased enrollment in managed care delivery systems and – to facilitate beneficiaries’ transitions and care management across product lines – promote cross-market alignment with Marketplace Qualified Health Plans (QHPs) and Medicare Advantage (MA). The final rule addresses these provisions of the ACA.

On Apr. 26, the USPSTF sought comment on its draft recommendation statement, “Primary Care Interventions to Support Breastfeeding” draft recommendation statement (here) and draft evidence review (PDF), which would update the USPSTF recommendation on counseling for breastfeeding. Comments are due by May 23, 2016.

On Apr. 28, the USPSTF released the final research plan for screening for prostate cancer.

On May 3, the USPSTF sought comments on a draft recommendation statement and draft evidence review on screening for celiac disease. The Task Force found insufficient evidence to recommend for or against screening in asymptomatic persons. Comments were due by May 30.

On May 5, the USPSTF released a draft research plan on screening for cardiovascular disease risk and atrial fibrillation with electrocardiography. The draft research plan is available for public comment through June 1.

On May 6, the USPSTF invited public comment on a draft recommendation statement and a draft evidence review for “Folic Acid for the Prevention of Neural Tube Defects.” Comments are due by June 6.

On May 12, the USPSTF posted a draft research plan on primary care interventions to prevent child maltreatment. The draft research plan is available for public comment through June 8.

On May 16, the Supreme Court sent Zubik v. Burwell back to lower courts to seek a compromise on first-dollar contraceptive coverage and religious accommodations.

On May 19, the USPSTF posted a draft research plan on interventions to prevent postpartum depression. The plan is available for public comment through June 15.

On May 26, the USPSTF posted a draft research plan on screening for intimate partner violence and abuse of elderly and vulnerable adults. The draft research plan is available for public comment through June 22.

On June 7, USPSTF published a final recommendation statement on screening for syphilis infection in non-pregnant adults and adolescents. Screening is strongly encouraged, with an “A” recommendation.

On June 14, the USPSTF sought comments on a draft recommendation statementand draft evidence review on screening for obstructive sleep apnea (OSA) in adults. The recommendation concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. Public comment is invited through July 11, 2016.

On June 16, the USPSTF posted a draft research plan on screening for elevated blood lead levels in childhood and during pregnancy. Comments are due by July 13, 2016.

On June 16, USPSTF posted a final research plan on screening for peripheral artery disease in adults with the ankle brachial index.

On June 16, the USPSTF released a final “A” recommendation on screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Screening from 76 to 85 gets a “C” grade, and the agency says the decision should be an individual one, based on the patient’s overall health and prior screening history.

On June 23, the USPSTF posted a final research plan on Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Adults.

On June 28, the USPSTF sought comments on a draft recommendation statement and draft evidence review on screening for gynecologic conditions with pelvic examination. The Task Force’s draft concludes that there is not enough evidence to determine the benefits and harms of performing screening pelvic examinations in asymptomatic, non-pregnant adult women (“I” statement). Comments are due by July 25, 2016.

On July 1, the USPSTF posted a final research plan on behavioral counseling to prevent skin cancer.

On July 18, the USPSTF issued a final research plan on screening for cardiovascular disease risk and atrial fibrillation with electrocardiography.

On July 26, the USPSTF issued a final recommendation statement concluding there is insufficient evidence to recommend for or against using visual clinical exams to screen adults for skin cancer.

On Aug. 2, the USPSTF on a draft recommendation statement and draft evidence review on serologic screening for genital herpes infection, with comments due by Aug. 29.

On Aug. 8, the USPSTF posted a draft research plan on primary care screening for drug use in adolescents and adults, including pregnant women. The draft research plan was available for public comment until Aug. 31.

On Aug. 9, the USPSTF released a final recommendation statement on screening for lipid disorders in children and adolescents. The Task Force concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger.

On Aug. 15, the USPSTF posted a final research plan on interventions to prevent perinatal depression.

On Aug. 18, the USPSTF posted a final research plan on primary care interventions to prevent child maltreatment.

On Aug. 25, the USPSTF posted a final research plan on screening for intimate partner violence, elder abuse, and abuse of vulnerable adults.

On Aug. 25, the USPSTF posted a draft research plan on screening and behavioral counseling interventions in primary care to reduce unhealthy alcohol use in adults and adolescents. Comments are due by Sept. 21.

On Aug. 25, CCIIO posted FAQs outlining its plans to collect data on third-party administrators’ contraceptive services payments under the religious organization accommodation for the 2015 benefit year. The agency will use a web-based form to obtain payment data, which will be used to reduce the applicable issuer’s Federally Facilitated Marketplace user fee to account for the payments. The FAQs explain data submission timelines and logistics.

On Sept. 6, the USPSTF released a final recommendation statement on screening for latent tuberculosis infection in adults. The Task Force issued a grade ‘B’ recommendation on screening among asymptomatic adults who are at increased risk of infection with tuberculosis.

On Sept. 28, the USPSTF issued a request for public comments on a draft recommendation statement and draft evidence review on screening for preeclampsia. In the statement, the Task Force issues a grade B recommendation in support of screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy. Comments are due by Oct. 24.

On Oct. 14, the USPSTF released a final research plan on screening for elevated blood lead levels in childhood and pregnancy.

On Oct. 24, the USPSTF posted a final research plan on screening for drug use in adolescents and adults, including pregnant women.

Also on Oct. 24, the USPSTF posted a final research plan on primary care screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults, including pregnant women.

On Oct. 26, the USPSTF reaffirmed its final “B” rating for primary care interventions to support breastfeeding.

On Nov. 1, the USPSTF announced an opportunity for public comment on the newly issued draft recommendation statement and draft evidence review on screening for obesity in children and adolescents. The comment period closed on Nov. 28, 2016.

On Nov. 14, the USPSTF released a final recommendation statement on statin use for the primary prevention of cardiovascular disease in adults. The Task Force found that statin use is beneficial for some people ages 40 to 75 years who are at increased risk for cardiovascular disease, but it did not find enough evidence to recommend for or against statin use for people older than age 75.

On Nov. 28, the USPSTF issued a draft recommendation statement and draft evidence review on screening for thyroid cancer. The draft statement assigns a “D” grade, meaning the USPSTF recommends against screening for thyroid cancer in asymptomatic adults. The Task force is seeking comments on the drafts through Dec. 26, 2016.

On Dec. 16, 2016, the USPSTF its sixth annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.

On Dec. 20, 2016, HRSA announced the updated Women’s Preventive Services Guidelines, for plan years beginning on or after Dec. 20, 2017.

2017

On Jan. 12, 2017, the USPSTF issued a final recommendation statement with an “A” rating for folic acid supplementation for the prevention of neural tube defects.

On Jan. 26, the USPSTF gave an “I” rating to screening asymptomatic adults for obstructive sleep apnea.

On Feb. 23, the USPSTF sought comment (due: Mar. 22) on three draft research plans related to HIV screening and prevention: pre-exposure prophylaxis (PrEP) for the prevention of HIV infection, screening for HIV infection in asymptomatic, non-pregnant adolescents and adults, and screening for HIV infection in pregnant women.

On Mar. 2, the USPSTF sought comment (due: Mar. 27) on a draft recommendation statementand draft evidence review related to vision screening for children ages 6 months to 5 years.

On Mar. 9, the USPSTF concluded that more research is needed to recommend for or against performing pelvic examinations in adult asymptomatic women.

On Mar. 23, the USPSTF posted a draft research plan related to medication use for the risk reduction of primary breast cancer in women. Public comments are due by Apr. 19.

On April 12, the USPSTF sought comments (due: May 8) on a draft recommendation statement and draft evidence reviews on screening for prostate cancer. The Task Force determined that the potential benefits and harms of prostate-specific antigen (PSA)-based screening are closely balanced in men ages 55 to 69 years, and that the decision about whether to be screened should be an individual one. For men age 70 years and older, the potential benefits do not outweigh the harms, and these men should not be screened for prostate cancer, the USPSTF said.

On April 19, AHRQ solicited nominations for new members to serve on the USPSTF, which were due on June 15.

On April 26, in final recommendation statement, the Task Force recommended screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy. The Task Force assigned a grade rating of “B” to the recommendation.

On May 1, the USPSTF Task Force sought comments regarding its draft research plan related to pancreatic cancer screening. Comments were due on May 24.

On May 4, in a broader executive order, President Trump directed HHS, Treasury, and DOL to reassess regulations and “address conscience-based objections” to ACA first-dollar preventive services coverage for women’s services, which include contraception. HHS Secretary Price said he welcomed the chance to reexamine the regulations and planned to take regulatory action shortly.

On May 10, in a final recommendation statement, the USPSTF recommended against screening for thyroid cancer in asymptomatic persons. The intervention received a grading of “D” indicating there is a moderate to high certainty that the service has no net benefit or that the harms outweigh the benefits.

On May 25, led by Sen. Patty Murray (D-WA), 14 Senate Democrats sent a letter urging OMB Director Mick Mulvaney not to target access to birth control coverage in his review of a pending interim final rule on ACA contraceptive coverage.

On May 31, an unpublished draft of a forthcoming HHS interim final rule that would expand an exemption to ACA contraceptive coverage requirements was leaked. The rule, which currently is under review by OMB and has not been published in the Federal Register, would expand an existing exemption to requirements that employers offer first-dollar contraceptive coverage to employees to a broader range of entities who object to such requirements on religious grounds.

On July 12, the USPSTF issued a grade of “C,” indicating that it recommends selectively offering behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors.

On July 17, the USPSTF released a draft research plan on screening for hepatitis B infection in pregnant women.

On July 19, the USPSTF sought comment (PDF here; deadline: Aug. 14) on its draft recommendation statement and draft evidence review regarding screening for ovarian cancer. The draft recommends against screening for ovarian cancer in asymptomatic women.

On July 24, the USPSTF posted a final research plan on medications to reduce the risk of breast cancer.

On Aug. 14, the USPSTF released a draft research plan addressing primary care screening for abdominal aortic aneurysm and accepted comments through Sept. 6.

On Aug. 24, the USPSTF released a final research plan on screening for pancreatic cancer.

On Aug. 28, the USPSTF released a final research plan on BRCA-related cancer, including risk assessment, genetic counseling, and genetic testing.

On Aug. 31, the USPSTF issued a final research plan on screening for syphilis infection in pregnant women.

On Sept. 8, the USPSTF released a final recommendation statement on vision screening in children ages 6 months to 5 years old. The Task Force recommends, with a grade of “B,” that clinicians should conduct visionscreening at least once in all children ages 3 to 5 years to detect amblyopia or its risk factors.

On Sept. 13, the USPSTF sought comments (due: Oct. 9) on a draft recommendation statementand draft evidence review on screening for cervical cancer.

On Sept. 21, the USPSTF released a draft research plan on screening adolescents and adults for hepatitis C virus. Comments are due by Oct. 18.

On Sept. 26, the USPSTF sought comments on draft recommendation statements and draft evidence reviews for two topics: 1) interventions to prevent falls in community-dwelling older adults, and 2) vitamin D, calcium, or combined supplementation for the primary preventionof fractures. Comments are due by Oct. 23.