Technical Design II Subcommittee
Meeting #2
Agenda Item #1: What activities/services should remain FFS and will be
considered VBP such as preventative care?
The tables below detail the preventative health coverage services addressed in 45 CFR 147.130.
Table 1 -- Preventive Care Services as per the United States Preventive Services Task Force 1
#
Recipient
1
Adults
2
Adults
3
Adults
4
5
6
7
8
9
Adults
Adults
Adults
Adults
Adults
Adults
10
Adults
11
Adults
12
Adults
13
14
15
16
17
18
19
20
21
22
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
23
Adults
Preventative Service
Abdominal Aortic Aneurysm one-time screening for men of specified ages who
have ever smoked
Alcohol Misuse screening and counseling
Aspirin use to prevent cardiovascular disease for men and women of certain
ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Diabetes (Type 2) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
Hepatitis C screening for adults at increased risk, and one time for everyone born
1945 – 1965
HIV screening for everyone ages 15 to 65, and other ages at increased risk
Immunization vaccines for adults — doses, recommended ages, and
recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Lung cancer screening: for adults 55 - 80 at high risk for lung cancer because
they’re heavy smokers or have quit in the past 15 years
CMS. Preventive health services for adults. Retrieved from https://www.healthcare.gov/preventive-carebenefits/adults/ on June 22, 2015
1
Technical Design II Subcommittee
Meeting #2
#
24
25
26
Recipient
Adults
Adults
Adults
27
Adults
1
Women
2
Women
3
4
Women
Women
5
Women
6
Women
7
Women
8
Women
9
10
Women
Women
11
Women
12
13
14
Women
Women
Women
15
Women
16
Women
17
Women
18
19
Women
Women
20
Women
21
22
1
2
Women
Women
Children
Children
Preventative Service
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher r
Syphilis screening for all adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco
users
Anemia screening on a routine basis for pregnant women
Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for
breast cancer
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breastfeeding comprehensive support and counseling from trained providers,
and access to breastfeeding supplies, for pregnant and nursing women
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher
risk
Contraception: Food and Drug Administration-approved contraceptive methods,
sterilization procedures, and patient education and counseling, as prescribed by
a health care provider for women with reproductive capacity (not including
abortifacient drugs). This does not apply to health plans sponsored by certain
exempt “religious employers.”
Domestic and interpersonal violence screening and counseling for all women
Folic Acid supplements for women who may become pregnant
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at
high risk of developing gestational diabetes
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
HIV screening and counseling for sexually active women
Human Papillomavirus (HPV) DNA Test every 3 years for women with normal
cytology results who are 30 or older
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for
women at higher risk
Sexually Transmitted Infections counseling for sexually active women
Syphilis screening for all pregnant women or other women at increased ris
Tobacco Use screening and interventions for all women, and expanded
counseling for pregnant tobacco users
Urinary tract or other infection screening for pregnant women
Well-woman visits to get recommended services for women under 65
Alcohol and Drug Use assessments for adolescents
Autism screening for children at 18 and 24 months
Technical Design II Subcommittee
Meeting #2
#
Recipient
Preventative Service
3
Children
Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4
years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
4
Children
Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to
4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
5
6
7
Children
Children
Children
Cervical Dysplasia screening for sexually active females
Depression screening for adolescents
Developmental screening for children under age 3
8
Children
9
Children
10
11
Children
Children
12
Children
Height, Weight and Body Mass Index measurements for children at the following
ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
13
14
15
16
Children
Children
Children
Children
Hematocrit or Hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
HIV screening for adolescents at higher risk
Hypothyroidism screening for newborns
17
Children
Immunization vaccines for children from birth to age 18 —doses, recommended
ages, and recommended populations vary:
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Children
Children
Children
Children
Children
Children
Children
Children
Children
Children
Children
Children
Children
Children
Diphtheria, Tetanus, Pertussis
Haemophilus influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza (Flu Shot)
Measles
Meningococcal
Pneumococcal
Rotavirus
Varicella
Iron supplements for children ages 6 to 12 months at risk for anemia
Lead screening for children at risk of exposure
32
Children
Medical History for all children throughout development at the following ages: 0
to 11 months, 1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years.
33
Children
Obesity screening and counseling
Dyslipidemia screening for children at higher risk of lipid disorders at the
following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Fluoride Chemoprevention supplements for children without fluoride in their
water source
Gonorrhea preventive medication for the eyes of all newborns
Hearing screening for all newborns
Technical Design II Subcommittee
Meeting #2
#
Recipient
34
Children
35
Children
36
Children
37
Children
38
Children
Preventative Service
Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4
years, 5 to 10 years.
Phenylketonuria (PKU) screening for this genetic disorder in newborns
Sexually Transmitted Infection (STI) prevention counseling and screening for
adolescents at higher risk
Tuberculin testing for children at higher risk of tuberculosis at the following
ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Vision screening for all children.
Table 2 -- Immunizations for routine use in children, adolescents, and adults that have in effect a
recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for
Disease Control and Prevention 2
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Vaccine-Specific ACIP
Recommendations
Anthrax
BCG
DTaP
Hepatitis A
Hepatitis B
Hib
HPV UPDATED
Influenza
Japanese Encephalitis
Measles, Mumps and Rubella
MMRV
Meningococcal
Pneumococcal
Polio
Rabies
Rotavirus
Smallpox (Vaccinia)
Tdap/Td
Typhoid
Varicella (Chickenpox)
Yellow Fever
Zoster (Shingles)
Center for Disease Control and Prevention. Vaccine Recommendations of the ACIP. Retrieved from
http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/index.html on July 8, 2015
2
Technical Design II Subcommittee
Meeting #2
Table 3.1 -- With respect to infants, children, and adolescents, evidence-informed preventive care and
screenings provided for in comprehensive guidelines supported by the Health Resources and Services
Administration: Recommendations for Preventive Pediatric Health Care 3
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Category
Measurements
Measurements
Measurements
Measurements
Measurements
Sensory Screening
Sensory Screening
Developmental/Behavioral Assessment
Developmental/Behavioral Assessment
Developmental/Behavioral Assessment
Developmental/Behavioral Assessment
Developmental/Behavioral Assessment
Developmental/Behavioral Assessment
Physical Examination
Procedures
Procedures
Procedures
Procedures
Procedures
Procedures
Procedures
Procedures
Procedures
Oral Health
Anticipatory Guidance
Recommendations for Preventive
Pediatric Health Care
Length/Height and Weight
Head Circumference
Weight for Length
Body Mass Index
Blood Pressure
Vision
Hearing
Developmental Screening
Autism Screening
Developmental Surveillance
Psychosocial/Behavioral Assessment
Alcohol and Drug Use Assessment
Depression Screening
Physical Examination
Newborn Blood Screening
Critical Congenital Heart Defect Screening
Immunization
Hematocrit or Hemoglobin
Lead Screening
Tuberculosis Testing
Dyslipidemia Screening
STI/HIV Screening
Cervical Dysplasia Screening
Oral Health
Anticipatory Guidance
Table 3.2 -- With respect to infants, children, and adolescents, evidence-informed preventive care and
screenings provided for in comprehensive guidelines supported by the Health Resources and Services
American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care. Retrieved from
http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/index.html on July 8, 2015
3
Technical Design II Subcommittee
Meeting #2
Administration: Recommendations of the Secretary’s Advisory Committee on Heritable Disorders in
Newborns and Children - Core Conditions 4
Table 3.3 -- With respect to infants, children, and adolescents, evidence-informed preventive care and
screenings provided for in comprehensive guidelines supported by the Health Resources and Services
U.S. Department of Health and Human Services. Advisory Committee on Heritable Disorders in Newborns and
Children. Retrieved from
http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders/recommendedpanel/uniformscreeni
ngpanel.pdf on July 8, 2015
4
Technical Design II Subcommittee
Meeting #2
Administration: Recommendations of the Secretary’s Advisory Committee on Heritable Disorders in
Newborns and Children - Secondary Conditions 5
U.S. Department of Health and Human Services. Advisory Committee on Heritable Disorders in Newborns and
Children. Retrieved from
http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders/recommendedpanel/uniformscreeni
ngpanel.pdf on July 8, 2015
5
Technical Design II Subcommittee
Meeting #2
Table 4 -- With respect to women, evidence-informed preventive care and screenings provided for in
binding comprehensive health plan coverage guidelines supported by the Health Resources and
Services Administration: Health Resources and Services Administration Women's Preventive Services
Guidelines 6
#
1
2
3
4
5
6
7
8
Type of Preventive Service
Well-woman visits
Screening for gestational diabetes
Human papillomavirus testing
Counseling for sexually transmitted infections
Counseling and screening for human immune-deficiency virus
Contraceptive methods and counseling*
Breastfeeding support, supplies, and counseling
Screening and counseling for interpersonal and domestic violence
*The guidelines concerning contraceptive methods and counseling described above do not
apply to women who are participants or beneficiaries in group health plans sponsored by
religious employer
U.S. Department of Health and Human Services. Women's Preventive Services Guidelines. Retrieved from
http://www.hrsa.gov/womensguidelines/ on July 8, 2015
6