[Federal Register Volume 87, Number 8 (Wednesday, January 12, 2022)]
[Notices]
[Pages 1762-1763]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-00461]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Updates to the Bright Futures Periodicity Schedule

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: Effective December 30, 2021, HRSA accepted recommended updates 
to the Bright Futures Periodicity Schedule, a HRSA-supported guideline 
for infants, children and adolescents for purposes of ensuring that 
non-grandfathered group and individual health insurance issuers provide 
coverage without cost sharing under the Public Health Service Act. The 
updates to the Bright Futures Periodicity Schedule are: A new category 
for sudden cardiac arrest and sudden cardiac death risk assessment, a 
new category for hepatitis B virus infection risk assessment, addition 
of suicide risk as an element of universal depression screening for 
children ages 12-21, and updated category title from ``Psychosocial/
Behavioral Assessment'' to ``Behavioral/Social/Emotional Screening,'' 
with no revision to the ages in which the screening occurs (newborn to 
21 years). Finally, two clarifying references related to dental 
fluoride varnish and fluoride supplementation have been added, with no 
associated recommended changes to clinical practice or health insurance 
coverage. Please see https://mchb.hrsa.gov/maternal-child-health-topics/child-health/bright-futures.html for additional information.

FOR FURTHER INFORMATION CONTACT: Savannah Kidd, M.S. MFT, HRSA/Maternal 
and Child Health Bureau by calling 301-287-2601 or by emailing at 
<a href="/cdn-cgi/l/email-protection#cc9f87a5a8a88ca4bebfade2aba3ba"><span class="__cf_email__" data-cfemail="97c4dcfef3f3d7ffe5e4f6b9f0f8e1">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: The Bright Futures program has been funded 
by HRSA since 1990. A primary focus of this program is for the funding 
recipient to maintain and recommend updates to the Bright Futures 
Guidelines for Health Supervision of Infants, Children and Adolescents, 
a set of materials and tools that provide theory-based and evidence-
driven guidance for all preventive care screenings and well-child 
visits. One component of these tools is the Bright Futures Periodicity 
Schedule, a chart that identifies the recommended screenings, 
assessments, physical examinations, and procedures to be delivered 
within preventive checkups at each age milestone. Over the program's 
existence, the Bright Futures Periodicity Schedule has become the 
accepted schedule within the United States for preventive health 
services through the course of a child's development.
    Section 2713 of the Public Health Service Act (42 U.S.C. 300gg-13), 
added by the Patient Protection and Affordable Care Act (Pub. L. 111-
148), requires that non-grandfathered group health plans and health 
insurance issuers offering

[[Page 1763]]

group or individual health insurance coverage provide coverage without 
cost-sharing for certain preventive health services. Section 2713(a)(3) 
describes such services for infants, children, and adolescents as 
``evidence-informed preventive care and screenings provided for in the 
comprehensive guidelines supported by the Health Resources and Services 
Administration.'' HHS, along with the Departments of Treasury and 
Labor, issued an Interim Final Rule on July 19, 2010 (75 FR 41726-
41760) that identified two specific resources as the comprehensive 
guidelines supported by HRSA for infants, children, and adolescents to 
be covered by insurance without cost sharing by non-grandfathered group 
health plans and health insurance issuers: (1) The Bright Futures 
Periodicity Schedule and (2) the Recommended Uniform Screening Panel of 
the Advisory Committee on Heritable Disorders in Newborns and Children. 
The Interim Final Rule provided that a future change to these 
comprehensive guidelines is considered to be issued for purposes of 
Section 2713 on the date on which it is accepted by the HRSA 
Administrator or, if applicable, adopted by the Secretary of HHS.
    A public comment period was announced and occurred from September 
13, 2021, through October 13, 2021 (86 FR 50894, September 13, 
2021),\1\ to allow public comment on the proposed recommended updates 
affecting clinical practice and health insurance coverage requirements. 
A total of 27 respondents gave 57 comments during the public comment 
period. The Bright Futures grantee, the American Academy of Pediatrics, 
received and considered the public comments. The annual report (Tab A) 
provides a description of the comments, including a detailed tabulation 
of each comment.
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    \1\ See https://www.federalregister.gov/documents/2021/09/13/2021-19630/opportunity-for-comments-on-proposed-updates-to-the-bright-futures-periodicity-schedule-as-part-of.
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    On December 30, 2021, the HRSA Administrator accepted the American 
Academy of Pediatrics' recommended several updates to the Bright 
Futures Periodicity Schedule. The Bright Futures recommendations 
included recommended clinical practice updates, along with revisions to 
the footnotes on the Bright Futures Periodicity Schedule that do not 
require changes to clinical practice or health insurance coverage. The 
updates to the Bright Futures Periodicity Schedule are: (1) A new 
category for sudden cardiac arrest and sudden cardiac death risk 
assessment, (2) a new category for hepatitis B virus infection risk 
assessment, (3) addition of suicide risk as an element of universal 
depression screening for children ages 12-21, and (4) updated category 
title from ``Psychosocial/Behavioral Assessment'' to ``Behavioral/
Social/Emotional Screening,'' with no revision to the ages in which the 
screening occurs (newborn to 21 years). Finally, two clarifying 
references related to dental fluoride varnish and fluoride 
supplementation have been added with no associated recommended changes 
to clinical practice. In light of these updates, all non-grandfathered 
group health plans and health insurance issuers offering group or 
individual health insurance coverage must cover without cost-sharing 
the services and screenings listed on the updated Bright Futures 
Periodicity Schedule for plan years (in the individual market, policy 
years) that begin in 2023, which can be accessed at the following link: 
https://mchb.hrsa.gov/maternal-child-health-topics/child-health/bright-futures.html.

Diana Espinosa,
Acting Administrator.
[FR Doc. 2022-00461 Filed 1-11-22; 8:45 am]
BILLING CODE 4165-15-P


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