[Federal Register Volume 89, Number 3 (Thursday, January 4, 2024)]
[Notices]
[Pages 472-473]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-28970]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Update to the Health Resources and Services Administration-
Supported Women's Preventive Services Guidelines Relating to Screening 
for Urinary Incontinence

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 September 29, 2023, 
detailed and sought public comment on recommendations under development 
by the Women's Preventive Services Initiative (WPSI), regarding updates 
to the HRSA-supported Women's Preventive Services Guidelines 
(Guidelines). The proposed updates specifically related to Screening 
for Urinary Incontinence. WPSI convenes health professionals to develop 
draft recommendations for HRSA's consideration. Two public comments 
were received and considered as detailed below. On December 28, 2023, 
HRSA accepted as final WPSI's recommended updates to the Screening for 
Urinary Incontinence 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 
Guidelines. The Departments of Labor, Health and Human Services, and 
the Treasury have previously issued regulations describing how group 
health plans and health insurance issuers apply the coverage 
requirements. Please see https://www.hrsa.gov/womens-guidelines for 
additional information.

FOR FURTHER INFORMATION CONTACT: Kimberly Sherman, HRSA, Maternal and 
Child Health Bureau, telephone: (301) 443-8283, 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 the Guidelines are required to be covered without cost-sharing 
by certain group health plans and health insurance issuers. HRSA 
established the Guidelines in 2011 based on expert recommendations by 
the Institute of Medicine, now known as the National Academy of 
Medicine, developed under a contract with the Department of Health and 
Human Services. Since 2016, HRSA has funded cooperative agreements with 
the American College of Obstetricians and Gynecologists for the Women's 
Preventive Services Initiative (WPSI) to convene a coalition 
representing clinicians, academics, and consumer-focused health 
professional organizations to conduct a rigorous review of current 
scientific evidence, solicit and consider public input, and make 
recommendations to HRSA regarding updates to the Guidelines to improve 
adult women's health across the lifespan. HRSA then determines whether 
to support, in whole or in part, the recommended updates to the 
Guidelines.
    WPSI includes an Advisory Panel and two expert committees, the 
Multidisciplinary Steering Committee and the Dissemination and 
Implementation Steering Committee, which are comprised of a broad 
coalition of organizational representatives who are experts in disease 
prevention and women's health issues. With oversight by the Advisory 
Panel, and with input from the Multidisciplinary Steering Committee, 
WPSI examines the evidence to develop new (and update existing) 
recommendations for women's preventive services. WPSI's Dissemination 
and Implementation Steering Committee takes HRSA-approved 
recommendations and disseminates them through the development of 
implementation tools and resources for both patients and practitioners.
    WPSI bases its recommended updates to the Guidelines on review and 
synthesis of existing clinical guidelines and new scientific evidence, 
following the National Academy of Medicine standards for establishing 
foundations for and rating strengths of recommendations, articulation 
of recommendations, and external reviews. Additionally, HRSA requires 
that WPSI incorporate processes to assure opportunity for public 
comment, including participation by patients and consumers, in the 
development of the updated Guidelines.
    WPSI proposed and HRSA has accepted recommended updates to the 
Guideline relating to Screening for Urinary Incontinence, which now 
reads, ``The Women's Preventive Services Initiative recommends 
screening women for urinary incontinence annually. Screening should 
assess whether women experience urinary incontinence and whether it 
impacts their activities and quality of life. If indicated, 
facilitating further evaluation and treatment is recommended.''
    Discussion of Recommended Updated Guideline Relating to Screening 
for Urinary Incontinence: WPSI recommended minor updates to the 
previous Guideline language. The first change is removal of the word 
``ideally'' from the second sentence, for clarity. Removal of the word 
``ideally'' does not substantively change the Guideline. The second 
change is in the final sentence, changing the word ``referring'' to 
``facilitating'' to reflect that clinicians in practice, after 
screening for urinary incontinence, may decide to treat or manage 
urinary incontinence as part of standard primary care services or refer 
to specialists if specialist care is needed. The change in language 
from ``referring'' to ``facilitating'' does not substantively change 
the Guideline. Lastly, WPSI recommended minor editorial revisions to 
the language of the Guideline, for clarity. These minor editorial 
revisions have no substantive effect on the Guideline.
    A Federal Register notice published on September 29, 2023, sought 
public comment on these proposed updates (88 FR 67318).\1\ WPSI 
considered all public comments as part of its deliberative

[[Page 473]]

process and provided the comments to HRSA for its consideration. Two 
respondents provided comments during the public comment period. One 
commenter suggested improving reimbursement by including billing codes 
for screening and counseling. This comment falls outside the scope of 
the Guidelines. The other commenter suggested adding the word ``co-
morbidities'' to a WPSI list of potential research topics. This comment 
was not accepted as it does not address the recommendation itself, but 
rather supporting materials.
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    \1\ See https://www.federalregister.gov/documents/2023/09/29/2023-21514/notice-of-request-for-public-comments-on-a-draft-recommendation-to-update-the-hrsa-supported-womens.
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    After consideration of public comment, WPSI submitted the 
recommended updates for Screening for Urinary Incontinence as detailed 
above. On December 28, 2023, the HRSA Administrator accepted WPSI's 
recommendations and, as such, updated the Women's Preventive Services 
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 on the 
updated Women's Preventive Services Guidelines for plan years (in the 
individual market, policy years) that begin 1 year after this date. 
Thus, for most plans, this update will take effect for purposes of the 
Section 2713 coverage requirement in 2025. Additional information 
regarding the Women's Preventive Services Guidelines can be accessed at 
the following link: https://www.hrsa.gov/womens-guidelines.
    Authority: Section 2713(a)(4) of the Public Health Service Act, 42 
U.S.C. 300gg-13(a)(4).

Carole Johnson,
Administrator.
[FR Doc. 2023-28970 Filed 1-3-24; 8:45 am]
BILLING CODE 4165-15-P