The document discusses how the Affordable Care Act (ACA) aims to improve access to preventive health services for women by requiring new health plans to cover recommended preventive services without cost sharing. This includes services for cancer screening, chronic disease prevention and management, vaccinations, healthy behaviors counseling, pregnancy-related care, and reproductive health services. The new rules apply to new private health plans starting in 2010 and 2012, with some exemptions for grandfathered and religious plans. Implementation will consider factors like network restrictions, separate billing for visits and services, and ensuring adequate provider training and capacity.

1. Preventive Women's Health Services &
Health Care Reform: Closing the Gaps
Key Considerations in Implementation
Alina Salganicoff, Ph.D.
Vice President and Director of Women’s Health Policy
Kaiser Family Foundation
March 18, 2012
Women's Health 2012 Congress
Washington, DC

2. Health care affordability is a barrier to care for
many women
Percentage of men and women who say they or a family member have done each of the following
in the past year because of COST:
Put off or postponed getting 29%
needed health care 26%
Skipped a recommended medical 25%
test or treatment 18%*
Women
28%
Didn’t fill a prescription 22% Men
*
20%
Cut pills or skipped doses of medicine
14%
*
33%
Skipped dental care or checkups
29%
Source:Kaiser Health Tracking Poll: (August 2011).
*Indicates statistical significance at the 95% level.

3. Costs often a problem even for insured women: How will
ACA change this for women?
*Significantly different from Private, p<.05.
Source: Ranji and Salganicoff, Kaiser Women’s Health Survey, 2008.

4. The Affordable Care Act makes improvements to
insurance that affect affordability for women
• Will make getting health coverage more
affordable and accessible
• Will ban “Gender Rating”
• Will ban exclusions for pre-existing
conditions
• Will require review of rate hikes
• Requires NEW plans to cover preventive
services without cost sharing

5. Adult Preventive Services to be Covered w/o Cost Sharing
Cancer Chronic Conditions Immunizations Healthy Behaviors Pregnancy-Related** Reproductive Health
Breast Cancer Cardiovascular health Td booster, Tdap Alcohol misuse Tobacco and cessation STI and HIV counseling
– Mammography for ⁻ Hypertension screening and interventions (adults at high risk; all
women 40+* screening MMR counseling (all adults) sexually-active
Alcohol misuse
– Genetic (BRCA) ⁻ Lipid disorders screening/counseling women♀)
Meningococcal Intensive healthy diet
screening and screenings
counseling (adults Rh incompatibility screening Screenings:
counseling ⁻ Aspirin  Hepatitis A, B
– Preventive medication w/high cholesterol, Gestational diabetes ⁻ Chlamydia (sexually
counseling Type 2 Diabetes Pneumococcal CVD risk factors, diet- screenings♀ active women <24y/o,
screening (adults w/ related chronic ⁻ 24-28 weeks gestation older women at high
Cervical Cancer elevated blood Zoster disease) ⁻ First prenatal visit (women risk)
‒ Pap testing (women pressure) at high risk for diabetes) ⁻ Gonorrhea (sexually
Influenza, Tobacco counseling active women at high
18+, Screenings
and cessation risk)
‒ High-risk HPV DNA Depression screening Varicella ⁻ Hepatitis B
interventions (all ⁻ Syphilis (adults at high
testing ♀ (adults, when follow ⁻ Chlamydia (<24, hi risk)
adults) risk)
up supports available) HPV (women 19-
⁻ Gonorrhea
Colorectal Cancer 26) ⁻ HIV (adults at high risk;
Interpersonal and ⁻ Syphilis
⁻ One of following: fecal Osteoporosis all sexually active
domestic violence ⁻ Bacteriurea
occult blood testing, screening (all women women♀)
screening and
colonoscopy, 65+, women 60+ at Folic acid supplements Contraception (women
counseling (women
sigmoidoscopy high risk) (women w/repro capacity) w/repro capacity) ♀
18-64)♀
⁻ All FDA approved
Iron deficiency anemia
Obesity Well-woman visits methods as prescribed,
screening
Screening (all adults) (women 18-64) ♀ ⁻ Sterilization procedures
Breastfeeding Supports ⁻ Patient education and
Counseling and
⁻ Counseling counseling
behavioral
⁻ Consultations with trained
interventions (obese
provider♀
adults)
⁻ Equipment rental♀
Sources:U.S. DHHS, “Recommended Preventive Services.” Available at http://www.healthcare.gov/center/regulations/prevention/recommendations.html.
More information about each of the services in this table, including details on periodicity, risk factors, and specific test and procedures are available at the following websites:
USPSTF: http://www.uspreventiveservicestaskforce.org/recommendations.htm
ACIP: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm#compHRSA Women’s Preventive Services: http://www.hrsa.gov/womensguidelines/

6. What types of plans are affected?
• All NEW private plans
– employer-sponsored
– individually purchased
– self insured
• “Grandfathered” plans exempted, but plans losing their
grandfather status (i.e. change benefits or cost-sharing) must
now cover ACA preventive services
• State Exchanges will include preventive services as Essential
Health Benefits
• Rules do not apply to Medicare, Medicaid, VA, IHS, and Military
health.

7. When do these new preventive
coverage rules take effect?
• TODAY: All NEW private insurance plans
must cover without cost-sharing, all services
recommended by USPSTF, ACIP, and Bright
Futures (effective 9/2010)
• In August 2012: All NEW private insurance
plans must also cover the HRSA
recommended services for women

8. What about religious exemptions?
• All “houses of worship” may be exempt from
ONLY the contraceptive coverage requirement if
they wish
• An HHS accommodation provided a one year
delay for religiously affiliated organizations that
object. In those cases, the insurer will be
required to cover the contraceptive services and
supplies -- NOT the employer
• Many details will be worked out over the
coming year

9. Any Other Caveats…?
• If service is performed by an out-of-network provider, insurers
may charge patients for the office visit and the preventive
service.
• If office visit and the preventive service billed separately,
insurer may impose cost-sharing for the office visit.
• If primary reason for visit is not preventive screening, patients
may have to pay for office visit. What happens when a women
wants a sterilization post-partum?
• Insurers can use reasonable judgment based on established
medical practices to make coverage decisions, if frequency not
specified

10. Considerations for Clinical Practice
• Well woman visit? What should be included?
• How do we adequately train providers to deliver
services? Is the current supply adequate?
• Contraceptive services: What happens to OTC
contraceptives? What about OCs and tiering?
Reasonable medical management rules apply…
• New opportunities to get coverage for
counseling for a wide range of issues, but is
there enough time in the visit?

11. Resources on Prevention, Women’s Health
and Health Reform
• IOM
– Clinical Preventive Services for Women: Closing the Gaps
http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-
Women-Closing-the-Gaps/Press-Release-MR.aspx
• HHS
– HHS ACA website http://www.healthcare.gov
– HRSA Guidelines http://www.hrsa.gov/womensguidelines/
• Kaiser Family Foundation
– The Impact of Health Reform on Women’s Access to Coverage and
Care http://www.kff.org/womenshealth/7987.cfm
– Preventive Services Covered by Private Health Plans under the
Affordable Care Act http://www.kff.org/healthreform/8219.cfm
– Health Reform Source: http://healthreform.kff.org/