GUIDING PRINCIPLES AND RECOMMENDATIONS

Recommendation 6.1: The committee recommends that the process for updating the preventive services for women covered under the ACA be:

  • Independent;
  • Free of conflict of interest;
  • Evidence-based;
  • Gender specific;
  • Life-course oriented;
  • Transparent;
  • Informed by systematic surveillance and monitoring;
  • Cognizant of the need to integrate clinical preventive services with effective interventions in public health, the community, the workplace, and the environment; and
  • Appropriately resourced to meet its mandate.

A PREVENTIVE SERVICES COVERAGE COMMISSION

The committee notes that coverage decisions must take into consideration a more extensive list of factors—including medicolegal considerations, ethical considerations, patient and provider preferences, cost, and cost-effectiveness—and that these decisions must be made in the context of the coverage decisions made in other clinical domains. Existing evidence review bodies (such as the United States Preventive Services Task Force [USPSTF]) focus on clinical evidence; and other bodies that develop clinical guidelines (professional organizations) do not have the methods, the expertise, or the independence to make coverage recommendations. The committee believes that the review of the evidence and decision making about coverage are two separate activities and that there is value in preserving the separation. Thus, the committee does not recommend adding coverage decision making to the scope of work of existing evidence review bodies or bodies that develop clinical guidelines.

Recommendation 6.2: The committee recommends that the Secretary of HHS establish a commission to recommend coverage of new preventive services for women to be covered under the ACA.

In carrying out its work, the commission should:

  • Be independent from bodies conducting evidence reviews, free of conflict of interest, and transparent;
  • Set goals for prevention (it may use available HHS reports and products or commission its own at its discretion);


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