July 22, 2016

Possible Third Year for USPSTF Guideline Moratorium

The American College of Radiology (ACR) supports a recent proposal in the House of Representatives to add an additional year to the current two-year delay for the implementation of U.S. Preventive Services Task Force (USPSTF) screening mammography recommendations.

The proposal to extend the moratorium until 2019 appeared in amended language in the House version of the Departments of Labor, Health and Human Service and Education and Related Agencies Appropriations Act (Labor-HHS Appropriations). Although the version of the appropriations bill that passed out of subcommittee did not include the provision, it was ultimately included as part of a manager’s amendment offered by subcommittee chairman Rep. Tom Cole (R-OK) during full committee consideration of the measure.

In January 2016, the USPSTF finalized recommendations assigning a “C” grade to routine mammography screening of women ages 40–49. The Task Force gave a “B” grade only to biennial mammography screening in women ages 50–74. The Affordable Care Act (ACA) only requires private insurers to cover exams or procedures given a grade of “B” or higher by the USPSTF.

The Consolidated Appropriations Act of 2016 placed a moratorium on those recommendations. As a result, private insurers are required to cover annual mammography screening without copayments for women 40 and older through January 1, 2018. The additional one-year moratorium, which has now been included in both the Senate and House Labor-HHS appropriation bills, is an important legislative priority for ACR.

In order to become law, the language will need to be included in a final spending package that is passed by both the full House and Senate and signed in to law by the President.

Labor-HHS appropriation bills are notoriously controversial and often only get passed in the context of a continuing resolution or omnibus bill that combines two or more appropriations bills into a large “must-pass” spending measure. However, having been included in both the House and Senate Labor-HHS appropriation bills, the additional one year moratorium provision is extremely well-positioned to be included in whatever measure ultimately becomes law.