2015-10-27 19:45:05 UTC

Administration Issues FAQ on Preventive Services Including Colonoscopy

Oct. 27, 2015

AGA is pleased with the new FAQ guidance and will continue to advocate that a positive stool blood test be defined as part of the screening continuum.

HHS, Department of Labor and Department of Treasury issued additional frequently asked questions (FAQ) on the Affordable Care Act’s (ACA) preventive services. Two of the questions specifically address issues associated with screening colonoscopy benefits for commercial health plans. 

Specifically, the departments provide additional clarification for cost sharing for patients who have a pre-procedure consultation before a colonoscopy and the pathology services required as part of the screening. Regarding the pre-procedure consultation, the departments state that cost sharing should not be imposed since the pre-procedure is “necessary to protect the health of the patient.” Cost sharing should be waived for pathology services, as well, since “the pathology exam is critical for achieving the primary purpose of the colonoscopy screening.” Read the FAQ.

AGA is pleased with this guidance. We continue to advocate that a positive stool blood test be defined as part of the screening continuum and therefore not subject patients to the cost sharing associated with the subsequent colonoscopy. We will continue to work with our partners in the patient and provider communities to seek additional guidance on the preventive benefits to ensure that financial barriers do not cause patients to forgo lifesaving screenings.

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