ACA Coverage Related to Cancer – Additional Clarifications

The US Departments of Labor, Health and Human Services, and the Treasury recently released further clarification regarding the implementation of the Affordable Care Act. Several of these clarifications relate to cancer:

Coverage of BRCA Testing

Q1: Must a plan or issuer cover without cost-sharing recommended genetic counseling and BRCA genetic testing for a woman who has not been diagnosed with BRCA-related cancer but who previously had breast cancer, ovarian cancer, or other cancer?

A1: Yes. The USPSTF recommends that "primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing." The USPSTF's Final Recommendation Statement related to BRCA testing indicates that the recommendation "applies to asymptomatic women who have not been diagnosed with BRCA-related cancer."

Coverage of Colonoscopies to USPSTF Recommendations

Q7: If a colonoscopy is scheduled and performed as a preventive screening procedure for colorectal cancer pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy

A7: No. The plan or issuer may not impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy if the attending provider determines that anesthesia would be medically appropriate for the individual.

To read the clarifications in their entirety click here.

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