Background: The United States Preventive Services Task Force (USPSTF) makes evidence-based recommendations about preventive services which are created for primary care professionals and by primary care professionals. The USPSTF was created in 1984.
Households became familiar with the USPSTF when the Affordable Care Act (ACA) required preventive services to be covered without cost-sharing. The USPSTF is the entity that determines what is considered preventive for the purposes of ACA and the no cost sharing provision.
Non-grandfathered private health insurance plans must cover in-network preventive services, that receive a grade A or B from the USPSTF, without cost sharing.
What is the new recommendation? The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18.
The USPSTF also continues to recommend depression and suicide risk screening for children and adolescents aged 12 to 18 years.
In order for the ACA no cost sharing provision to apply, the screenings must be coded as preventive. For patients presenting signs or symptoms, the physician would indicate the visit as diagnostic; thus, cost sharing can be imposed.
When does the new recommendation go into effect? Plan years beginning on or after one year following the publication of any new guideline.
The youth screening recommendation was published on October 11, 2022. This means that non-grandfathered group health plans must cover, without cost share, in-network screenings for plan years beginning on or after October 11, 2023. For example, a Plan that renews on January 1 will not need to comply until January 1, 2024.
Which group health plans must comply? Any private group health plan that is not grandfathered.
Those plans that maintained grandfathered status are not subject to the preventive services cost sharing rule.
Fully insured group health plans should rely on their carrier to comply for plan years starting on or after October 11, 2023.
Self-insured group health plans should work with their TPA to verify that necessary plan changes are made for plan years starting on or after October 11, 2023.
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.
This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.