On March 11, 2022, Commissioner Downing issued an Advisory Memo regarding coverage of preventive colonoscopies without cost-sharing. The memo follows recent federal guidance based on a recommendation by the United States Preventive Services Task Force (USPSTF).
The ACA requires group health plans and health insurers to cover certain preventive services without cost-sharing, including evidence-based items and services with an “A” or “B” recommendation by the USPSTF. The USPSTF recommends an “A” rating screening for colorectal cancer for adults aged 50 to 75 years and recently extended its recommendation with a “B” rating to adults aged 45 to 49 years. In May 2021, the USPSTF updated its recommendation for colorectal cancer screening to indicate that a follow-up colonoscopy is required after abnormal direct visualization or stool screening tests.
Based upon the USPSTF recommendation, the DOL, HHS and IRS issued guidance in January 2022 that requires group health plans and insurers to cover follow-up colonoscopies. Specifically, coverage must be provided without cost-sharing for a colonoscopy conducted after a positive non-invasive stool-based screening test or direct visualization screening test for colorectal cancer for individuals described in the USPSTF recommendation.
Employers should be aware of this coverage requirement, which is effective for plan years beginning on or after May 31, 2022. Additionally, they should review the memo and the referenced federal guidance for further details.
2022-03-11 Advisory Memorandum Regarding Coverage of Preventative Colonoscopies without Cost Sharing »
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