[Federal Register Volume 88, Number 3 (Thursday, January 5, 2023)]
[Notices]
[Pages 873-874]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-28661]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Update to the Bright Futures Periodicity Schedule as Part of the 
HRSA-Supported Preventive Services Guidelines for Infants, Children, 
and Adolescents

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

ACTION: Notice.

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SUMMARY: A Federal Register notice published on November 2, 2022, 
detailed and sought public comment on recommendations under development 
by the Bright Futures Pediatric Implementation Program (Bright Futures 
Program), regarding updates to the HRSA-supported preventive services 
guidelines for infants, children, and adolescents in the Bright Futures 
Periodicity Schedule. The proposed updates are specifically related to 
increasing the upper age limit for Human Immunodeficiency Virus (HIV) 
screening. The Bright Futures Program convenes health professionals to 
develop draft recommendations for HRSA's consideration. Ten comments 
were received and considered as detailed below. On December 30, 2022, 
HRSA accepted as final the Bright Future Program's recommended update 
to the HIV screening guideline. Under applicable law, non-grandfathered 
group health plans and health insurance issuers offering non-
grandfathered group and individual health insurance coverage must 
include coverage, without cost sharing, for certain preventive 
services, including those provided for in the HRSA-supported preventive 
services guidelines for infants, children, and adolescents. The 
Departments of Labor, Health and Human Services, and the Treasury have 
previously issued regulations, which describe how group health plans 
and health insurance issuers apply the coverage requirements. Please 
see https://mchb.hrsa.gov/programs-impact/bright-futures for additional 
information.

FOR FURTHER INFORMATION CONTACT: Bethany Miller, HRSA, Maternal and 
Child Health Bureau, telephone: (301) 945-5156, email: 
[email protected].

SUPPLEMENTARY INFORMATION: Under the Patient Protection and Affordable 
Care Act, Public Law 111-148, the preventive care and screenings set 
forth in HRSA-supported guidelines are required to be covered without 
cost-sharing by certain group health plans and health insurance 
issuers. The Department adopted the Bright Futures Periodicity Schedule 
as a HRSA-supported guideline for infants, children, and adolescents 
under section 2713 of the Public Health Service Act. See 75 FR 41726, 
41740 (July 19, 2010). To develop recommendations for HRSA's 
consideration, the Bright Futures Program convenes a panel of pediatric 
primary care experts to conduct rigorous reviews of current scientific 
evidence, solicit and consider public input, and make recommendations 
to HRSA regarding screenings and assessments recommended at each well-
child visit from infancy through adolescence. HRSA then determines 
whether to support, in whole or in part, the recommended updates. The 
schedule of preventive care and screenings for infants, children, and 
adolescents is reflected in the Bright Futures Periodicity Schedule. 
This work is supported through the Bright Futures Program via 
cooperative agreement with the American Academy of Pediatrics.
    The Bright Futures Program convenes a panel of pediatric primary 
care experts that examines the evidence to develop new (and update 
existing) recommendations for pediatric preventive services. The Bright 
Futures Program also disseminates final HRSA-supported recommendations 
through the annual publication of the updated Bright Futures 
Periodicity Schedule, with associated resources for practitioners and 
families.
    The Bright Futures Program bases its recommended updates to the 
Guidelines on review and synthesis of existing clinical guidelines and 
new scientific evidence. Additionally, HRSA requires that the Bright 
Futures Program incorporate processes to assure opportunity for public 
comment in the development of the updated Bright Futures Periodicity 
Schedule.
    The Bright Futures Program proposed and HRSA has accepted 
recommended updates to the Bright Futures Periodicity Schedule relating 
to increasing the upper age limit for Screening for HIV as detailed 
below.

Screening for HIV

    In the current Bright Futures Periodicity Schedule, the age range 
recommended for adolescent universal screening for HIV is between the 
15-year visit and 18-year visit. The Bright Futures Program proposed 
and HRSA has accepted an update that would expand the recommended age 
range for adolescent universal screening for HIV to between the 15-year 
visit and 21-year visit.
    In the Bright Futures Periodicity Schedule, a ``dot'' with an 
``arrow'' indicates a ``range during which a service may be provided.'' 
The previous guideline and updated guideline on HIV screening is 
reflected in the chart below:
[GRAPHIC] [TIFF OMITTED] TN05JA23.006

    All such screenings (universal and risk-based) within this age 
range are within the scope of the guideline. The update also includes 
an accompanying footnote to provide updated information about more 
frequent screening for youth assessed as at high risk of HIV infection. 
The full footnote reads: ``Screen adolescents for HIV at least once 
between the ages of 15 and 21 making every effort to preserve 
confidentiality of the adolescent, as per ``Human

[[Page 874]]

Immunodeficiency Virus (HIV) Infection: Screening'' (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening), and after initial 
screening, youth at increased risk of HIV infection should be retested 
annually or more frequently, as per ``Adolescents and Young Adults: The 
Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV 
Prophylaxis'' (https://doi.org/10.1542/peds.2021-055207).

Discussion of Recommended Updated Guidelines

    Early detection of an infection with HIV in adolescents and young 
adults can lead to improved health outcomes and reduce the further 
spread of HIV by individuals who are not yet aware they are infected. 
Universal screening is a type of screening that a provider may 
recommend without first identifying a specific risk factor or symptom. 
Given the sustained high numbers of people living with HIV in the 
United States; documented missed opportunities for HIV testing; 
advances in HIV diagnostics, treatment, and prevention; and age 
stratified epidemiological data around HIV incidence and HIV risk 
related behaviors, the range for universal screening is being extended 
to the 21-year visit.1 2 The aim is to better detect, treat, 
support, and prevent HIV infection among adolescents and youth, as well 
as the population at large.
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    \1\ Hsu KKC, Rakhmanina NY, Chadwick EG. et al. Adolescents and 
young adults: the pediatrician's role in HIV testing and pre- and 
postexposure HIV prophylaxis. Pediatrics 2022; 149 (01) e2021055207.
    \2\ US Preventive Services Task Force Final Recommendation 
Statement: Human Immunodeficiency Virus (HIV) Infection: Screening. 
2019. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening.
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    A Federal Register notice on November 2, 2022 sought public comment 
on these proposed updates (87 FR 66197).\3\ The Bright Futures Program 
considered all public comments as part of its deliberative process and 
provided the comments to HRSA for its consideration. A total of 10 
responders provided comments, the majority of whom agreed with the 
proposed update. Two respondents provided additional views. One comment 
suggested lowering the screening age range. Current clinical guidance 
to begin universal screening at age 15 is based on the age-stratified 
incidence of HIV infection and data on sexual activity in youth. No 
changes were made in response to this comment. The other comment did 
not specifically address HIV screening and is therefore beyond the 
scope of the proposed update.
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    \3\ See https://www.federalregister.gov/documents/2022/11/02/2022-23845/notice-of-request-for-public-comment-on-proposed-update-to-the-bright-futures-periodicity-schedule.
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    After consideration of public comment, the Bright Futures Program 
submitted recommended updates for HIV screening to HRSA for 
consideration, as detailed above. On December 30, 2022, the HRSA 
Administrator accepted the Bright Futures Program recommendations and, 
as such, updated the guidelines. Non-grandfathered group health plans 
and health insurance issuers offering group or individual health 
insurance coverage must cover without cost-sharing the services and 
screenings listed as the HRSA-supported preventive services guidelines 
for infants, children, and adolescents for plan years (in the 
individual market, policy years) that begin one year after this date. 
Thus, for most plans, this update will take effect for purposes of the 
Section 2713 coverage requirement in 2024. Additional information 
regarding the Bright Futures Program can be accessed at the following 
link: https://mchb.hrsa.gov/maternal-child-health-topics/child-health/bright-futures.html.
    Authority: Section 2713(a)(4) of the Public Health Service Act, 42 
U.S.C. 300gg-13(a)(4).

Carole Johnson,
Administrator.
[FR Doc. 2022-28661 Filed 1-4-23; 8:45 am]
BILLING CODE 4165-15-P