On March 30, 2023, a U.S. District Court held that services recommended by the U.S. Preventive Services Task Force issued since March 2010 pertaining to the ACA coverage requirements are unlawful. Coverage requirements for vaccines recommended by CDC’s Advisory Committee on Immunization Practices (ACIP), women’s health services recommended by the Health Resources & Services Administration (HRSA), and certain services for children and adolescents recommended by Bright Future are not impacted. Below is an analysis of the impact of the decision on the preventive services impacting liver disease. The most significant impact is on screening for hepatitis B and C, which are no longer required covered services. Plans may choose to cover these preventive services, but they will be permitted to impose cost-sharing.
| Topic | Impacted by Decision? | Description of Impact | Other Notes: |
| Screening for Hepatitis B | Yes. The current recommendation for screening for hepatitis B virus infection in adolescents and adults at increased risk for infection would be impacted. | The services for required coverage would revert back to the 2004 recommendation, which recommends against routinely screening the general asymptomatic population for chronic hepatitis B virus infection. | It is likely that plans will no longer be required to cover screening for hepatitis B with no cost-sharing. Note that plans may still choose to cover this service but may impose cost-sharing. |
| Screening for Hepatitis C | Yes. The current recommendation for screening adults aged 18-79 for hepatitis C virus infection is impacted by the decision. | The services for required coverage would revert back to the 2004 recommendation, which recommends against routine screening for hepatitis C virus infection in asymptomatic adults who are not at increased risk (general population) for infection. | It is likely that plans will no longer be required to cover screening for hepatitis C with no cost-sharing. Note that plans may still choose to cover this service but may impose cost-sharing. |
| Screening for Diabetes Type 2 | Yes. The current recommendation for screening for prediabetes and type 2 diabetes in adults aged 35-70 who are overweight or obese is impacted. | The services for required coverage would revert back to the 2008 recommendation, which recommends screening in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80mmHG. | |
| Diet Counseling | Yes. The current recommendations for offering or referring adults with cardiovascular disease risk factors to behavioral counseling interventions to promote a healthy diet and physical activity is impacted. | The services for required coverage would revert back the 2003 recommendation by the USPSTF. The 2003 recommendation is for intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. | The patient population for which such counseling will be available at no cost-sharing will likely change. |
| Obesity Screening for Children and Adolescents | Yes. The current recommendation is for screening children and adolescents 6 years and older for obesity and offer/refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. | The services for required coverage would revert back to the 2010 recommendation by the USPSTF. The 2017 and 2010 recommendations appear to be very similar in wording. | The decision may not have a meaningful impact. However, the USPSTF is currently updating the recommendation, which may be placed on hold until litigation is exhausted. |
| Weight Loss Behavioral Health Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults | Yes. The current recommendation is that clinicians offer or refer adults with a body mass index of 30 or higher to intensive, multicomponent behavioral interventions. | The services would revert back to the 2003 recommendation by the USPSTF – which is for clinicians to screen all patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults (with BMI over 30). | The impact of reverting back to the 2003 recommendation may be minimal. |
| STI Prevention Counseling | Yes. The recommendations for STI behavioral counseling for all sexually active adolescents and adults at increased risk for STIs would be impacted. | The services for required coverage would revert back to the 2008 recommendation by the USPSTF – which is that sexually active adolescents and adults receive behavioral counseling to prevent STIs. | The coverage requirements for annual STI counseling for all sexually active women is not impacted by the decision, as this recommendation was made by HRSA. |
| Immunizations for Hepatitis B and C | Not impacted | N/A | Immunizations are recommended by ACIP and are therefore not impacted by the Court’s decision. |
