USPSTF Recommends Syphilis Screenings for Adolescents and Certain Adults Under ACA Preventive Health Services Rules | Practical Law

USPSTF Recommends Syphilis Screenings for Adolescents and Certain Adults Under ACA Preventive Health Services Rules | Practical Law

The US Preventive Services Task Force (USPSTF) has issued a final recommendation on screening for syphilis infection in adolescents and adults who are at increased risk for infection. The recommendation has a grade "A" rating, which means group health plans and health insurers must cover the screening without cost-sharing under the Affordable Care Act (ACA), subject to a delayed applicability date.

USPSTF Recommends Syphilis Screenings for Adolescents and Certain Adults Under ACA Preventive Health Services Rules

by Practical Law Employee Benefits & Executive Compensation
Published on 02 Oct 2022 • USA (National/Federal)
The US Preventive Services Task Force (USPSTF) has issued a final recommendation on screening for syphilis infection in adolescents and adults who are at increased risk for infection. The recommendation has a grade "A" rating, which means group health plans and health insurers must cover the screening without cost-sharing under the Affordable Care Act (ACA), subject to a delayed applicability date.
The US Preventive Services Task Force (USPSTF) has issued a final recommendation on screening for syphilis infection in adolescents and adults who are at increased risk for infection (USPSTF Recommendation; related press release (Sept. 27, 2022)).
Under the Affordable Care Act (ACA), as background, group health plans and health insurers must provide first-dollar coverage for evidence-based items or services, including various types of screenings, with a rating of "A" or "B" under current recommendations from the USPSTF. Plans and insurers generally must provide coverage for newly added preventive service requirements for plan years beginning on and after the date that is one year after the date the recommendation is issued. The USPSTF is an independent panel of scientific experts with training and experience appropriate to making health care recommendations. For more information, see:
Syphilis is a sexually transmitted infection (STI) that:
  • Progresses in stages.
  • Can lead to significant health problems if not treated (including damage to the brain, nerves, and cardiovascular system).
The USPSTF's final recommendation on syphilis, which has an "A" rating, applies to asymptomatic adolescents and adults who:
  • Have ever been sexually active.
  • Are not pregnant.
  • Are at increased risk for infection.
The final recommendation includes guidelines for health providers to use when assessing whether an individual is at increased risk for syphilis infection, including rates in the local community, certain types of behaviors, and other risk factors. For example, the guidance indicates that syphilis rates are higher in:
USPSTF's recommendation was driven in part by syphilis infection rates, which have increased over the past 20 years after reaching a record low in 2000.

Practical Impact

Last month, a Texas district court—in litigation challenging the USPSTF's 2019 recommendations of pre-exposure prophylaxis (PrEP) drugs to prevent HIV infections—held that the appointment of USPSTF members violated the Constitution's Appointments Clause (Braidwood Mgmt. Inc. v. Becerra, (N.D. Tex. Sept. 7, 2022); see Legal Update, District Court: ACA's HIV/PrEP Coverage Mandate Violates the RFRA: Appointment of USPSTF's Members Violated Appointments Clause). The district court in that case did not address the appropriate remedy for the violation, though the court indicated that the Secretary of HHS could not merely ratify the USPSTF's actions. (This was because the government had taken the position in the litigation that the Secretary had no authority over the USPSTF.) It remains to be seen whether this latest USPSTF recommendation also will be challenged in litigation.