IOM Recommendations Call for HHS To Require Contraception Coverage

HHS should require that new health plans cover all FDA-approved contraception without cost-sharing by consumers as part of the essential benefit package under the federal health reform law, an Institute of Medicine panel said in guidelines issued on Tuesday, Politico reports.

Last year, HHS Secretary Kathleen Sebelius asked the independent panel to examine what constitutes a "preventive service" for women as part of a provision in the reform law that requires health plans to cover such services without copayments or deductibles.

Sebelius said the department is examining the panel's recommendations "closely" and will make a final decision "very soon" (Nocera, Politico, 7/19). Sebelius could issue the final regulations by Aug. 1. The Obama administration has said it is inclined to adopt the panel's recommendations, which could take effect for many plans in early 2013 (Pear, New York Times, 7/19).

Contraception Coverage

The panel urged coverage for "the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling."

The recommendations were endorsed by 15 of the 16 panel members. The committee wrote that contraceptive coverage is now "standard practice" for most private insurers and federal insurance programs (Levey, Los Angeles Times, 7/20).

Other Recommendations

IOM recommended that certain other preventive services for women be covered without out-of-pocket fees:

• Domestic violence screening and counseling services;
• Advanced screenings for cervical cancer and human papillomavirus for women ages 30 and older;
• Counseling for sexually transmitted infections and HIV;
• Screening for gestational diabetes for pregnant women; and
• Comprehensive coverage of breastfeeding equipment and support.

The report also requires coverage for at least one annual preventive health exam.

The report did not indicate how much all the recommendations would cost (Hobson, Wall Street Journal, 7/20). However, the report noted that the direct medical costs of unintended pregnancy in the U.S. were an estimated $5 billion in 2002, while the cost savings from contraceptive use in the same year were an estimated $19.3 billion.

Relation to Reform Law

According to the Washington Post, the rules regarding preventive services for women are part of a broader provision in the federal health reform law that requires plans to provide coverage without additional cost-sharing for preventive care services for men, women and children (Aizenman, Washington Post, 7/19).

An amendment to the law introduced by Sen. Barbara Mikulski (D-Md.) required that the overhaul examine and grant "additional preventive care and screenings" for women (New York Times, 7/19).

Timeline

An HHS official said that if the department were to adopt the recommendations by Aug. 1, "non-grandfathered plans would have to cover [contraception] in the first plan year beginning after Aug. 1, 2012. For many plans, this will be Jan. 1, 2013."

The official said that in 2011, "an estimated 31 million people in new employer plans and 10 million people in new individual plans will benefit from the new prevention provisions under the Affordable Care Act. The number of individuals in employer plans who will benefit from the prevention provisions is expected to rise to 70 million by 2013, for a total potential of 88 million Americans whose prevention coverage will improve due to the new policy."

Meanwhile, "many of the 98 million people in group health plans that are expected to be 'grandfathered' and thus not subject to these regulations already have preventive services," the official explained (Reichard, CQ HealthBeat, 7/19).