[Federal Register Volume 86, Number 159 (Friday, August 20, 2021)]
[Notices]
[Pages 46856-46857]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-17826]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Updated HRSA-Supported Women's Preventive Services Guidelines: 
Well-Women Preventive Visits, Counseling for Sexually Transmitted 
Infections, and Breastfeeding Services and Supplies

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: This notice seeks comments on an updated draft recommendation 
for Well-Woman Preventive Visits, Counseling for Sexually Transmitted 
Infections, and Breastfeeding Services and Supplies, as part of the 
HRSA-supported Women's Preventive Services Guidelines. This updated 
draft recommendation has been developed through a national cooperative 
agreement, the Women's Preventive Services Initiative (WPSI), by the 
American College of Obstetricians and Gynecologists (ACOG). Under the 
Public Health Service Act, as added by the Patient Protection and 
Affordable Care Act, non-grandfathered group health plans and non-
grandfathered group and individual health insurance issuers must 
include coverage, without cost sharing, for certain preventive services 
under that section, including those provided for in the HRSA-supported 
Women's Preventive Services Guidelines (Guidelines).

DATES: Members of the public are invited to provide written comments no 
later than September 20, 2021. All comments received on or before this 
date will be reviewed and considered by the WPSI Multidisciplinary 
Steering Committee.

ADDRESSES: Members of the public interested in providing comments on 
the draft recommendation statements can do so by accessing the 
initiative's web page at https://www.womenspreventivehealth.org/.

FOR FURTHER INFORMATION CONTACT: Kimberly Sherman, HRSA, Maternal and 
Child Health Bureau, telephone (301) 443-8283, email: 
[email protected].

SUPPLEMENTARY INFORMATION: The HRSA-supported Women's Preventive 
Services Guidelines were originally established in 2011 based on a 
study and recommendations by the Institute of Medicine, now known as 
the National Academy of Medicine, commissioned by HHS. Since then, 
there have been advancements in science and gaps identified in these 
guidelines, including a greater emphasis on practice-based clinical 
considerations. In March 2016, HRSA awarded a 5-year cooperative 
agreement to convene a coalition representing clinicians, academics, 
and consumer-focused health professional organizations to conduct a 
rigorous review of current scientific evidence and recommend updates to 
existing guidelines. The ACOG was awarded the cooperative agreement and 
formed the WPSI, which consists of an Advisory Panel and two expert 
committees; the Multidisciplinary Steering Committee (MSC) and the 
Dissemination and Implementation Steering Committee, to improve adult 
women's health across the lifespan by engaging a coalition of health 
professional organizations to review evidence and recommend updates to 
the HRSA-supported Women's Preventive Services Guidelines. HRSA would 
then decide whether or not to support, in whole or

[[Page 46857]]

in part, the recommended updates to the Guidelines.
    In March 2021, ACOG was awarded a subsequent cooperative agreement 
to further review and recommend updates to the Guidelines. As the award 
recipient, starting on March 1, 2021, ACOG has engaged in a process to 
consider and review new information developed by a multidisciplinary 
group of women's health professional organizations. Following 
recommendations by ACOG, HRSA will decide whether to support, in whole 
or in part, the recommended updates to the guidelines.
    As part of this cooperative agreement, ACOG is required to base its 
recommended updates to the Guidelines on review and synthesis of 
existing clinical guidelines and new scientific evidence. The National 
Academy of Medicine standards for establishing foundations for and 
rating strengths of recommendations, articulation of recommendations, 
as well as external reviews are to be met in developing these 
guidelines. Additionally, processes are to be incorporated to assure 
opportunity for public input and transparency, including participation 
by patients and consumers, in the development of the updated Guideline 
recommendations.
    This notice solicits comments from the public on the draft 
recommendation statements for the Well-Woman Preventive Visits, 
Counseling for Sexually Transmitted Infections, and Breastfeeding 
Services and Supplies. The updated draft clinical recommendation 
statements are provided below:

Well Woman Preventive Visits

    The MSC has updated the clinical recommendation statement to 
reflect that recommended services may be completed at a single visit or 
as part of a series of preventive health visits that take place over 
time to obtain the necessary services. Well Women Visits have also been 
further defined to include pre-pregnancy, prenatal, and interpregnancy 
visits.

    ``The WPSI recommends that women receive at least one preventive 
care visit per year beginning in adolescence and continuing across 
the lifespan to ensure the provision of all recommended preventive 
services. These services may be completed at a single visit or as 
part of a series of visits that take place over time to obtain all 
necessary services depending on a woman's age, health status, 
reproductive health needs, pregnancy status, and risk factors. Well 
women visits include pre-pregnancy, prenatal, and interpregnancy 
visits. The primary purpose of well-woman visits is the delivery and 
coordination of all recommended preventive services as determined by 
age and risk factors.''

Counseling for Sexually Transmitted Infections

    The MSC has made minor updates to the counseling for sexually 
transmitted infections statement to include a review of a women's 
sexual history, and modified the risk factor list by stating that risk 
factors are ``not limited to'' the areas indicated.

    ``The WPSI recommends directed behavioral counseling by a health 
care provider or other appropriately trained individual for sexually 
active adolescent and adult women at an increased risk for sexually 
transmitted infections (STIs).
    The WPSI recommends that health care providers review a woman's 
sexual history and risk factors to help identify those at an 
increased risk of STIs. Risk factors include but are not limited to 
age younger than 25 years, a recent history of an STI, a new sex 
partner, multiple partners, a partner with concurrent partners, a 
partner with an STI, and a lack of or inconsistent condom use. For 
adolescents and women not identified as high risk, counseling to 
reduce the risk of STIs should be considered, as determined by 
clinical judgment.''

Breastfeeding Services and Supplies

    The MSC has updated the clinical recommendation to include 
consultative services that will optimize successful initiation and 
maintenance of breastfeeding.

    ``The WPSI recommends comprehensive lactation support services 
(including consultation, counseling, education, and breastfeeding 
equipment and supplies) during the antenatal, perinatal, and 
postpartum periods to optimize the successful initiation and 
maintenance of breastfeeding.''

    Members of the public can view each complete updated draft 
recommendation statement by accessing the initiative's web page at 
https://www.womenspreventivehealth.org/.

Diana Espinosa,
Acting Administrator.
[FR Doc. 2021-17826 Filed 8-19-21; 8:45 am]
BILLING CODE 4165-15-P