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The Affordable Care Act requires many insurance plans to provide coverage for certain recommended preventive health services without requiring a copayment, coinsurance or deductible.
The Department of Health and Human Services (HHS) has adopted guidelines for women's preventive health services which will help ensure that women can receive, without cost-sharing, a comprehensive set of recommended preventive health services, including screening and counseling for interpersonal and domestic violence. Many health plans will be required to cover these services without cost-sharing for plan or policy years beginning on or after August 1, 2012. The guidelines adopted by HHS are based on recommendations from the Institute of Medicine.
Interpersonal and domestic violence has a profound impact on the health of women and girls. Violence and trauma can result in serious injuries and death, and lead to chronic health problems.
Identifying current or past abusive and traumatic experiences can help prevent further abuse, lessen disability, and lead to improved health status. Because they are often trusted resources in their communities, health care providers are in a unique position to connect women who experience interpersonal and domestic violence with support.
Providers do not need to be experts on interpersonal and domestic violence to conduct screenings. Screening can occur during a well-woman visit with a primary care provider or as part of any other health care visit.
Just as providers routinely screen patients for diabetes or high blood pressure and refer them to specialists as needed, providers can also screen for interpersonal and domestic violence and provide a referral to local domestic violence programs and services. If a woman discloses abuse, the provider can provide brief counseling to: 1) promote the patient's immediate safety; 2) discuss the possible relationship between current or previous interpersonal and domestic violence and the patient's health concerns; and, 3) link the patient to support services and resources.
Before screening a patient, providers should be aware that certain states have mandatory interpersonal and domestic violence reporting laws. Fear that their situation might be reported to police or child protective services may prevent a victim from disclosing abuse. Because state reporting laws vary and patients' assessment of their own safety is paramount, it is important to discuss any confidentiality issues with patients. For more information on reporting laws in your state, please see the resources at www.acf.hhs.gov/fvpsa.
Many health care providers are uncertain about how to handle a disclosure of abuse and unsure about how to provide counseling. As is the case when referring patients to other specialists, providers screening for interpersonal and domestic violence are not expected to have all the answers. For this reason, providers should consider identifying local resources and making contact with domestic violence and sexual violence support services ahead of time. Then providers can more readily make a referral upon disclosure of abuse, including referrals in which providers give women information so that the women can make the best decision for themselves. Providers can learn more about referring to local domestic violence and sexual violence programs by contacting their state coalition against domestic violence or the National Domestic Violence Hotline.
The Administration for Children and Families (ACF) supports the National Health Resource Center on Domestic Violence (NHRCDV). In collaboration with health care providers, national domestic violence organizations and health associations, the NHRCDV produces guidelines and practical tools for responding to interpersonal and domestic violence in health care settings. For more on the NHRCDV and other resources from ACF, please visit ACF's Division of Family Violence Prevention website.
More information for providers is available in Question 11 of the Affordable Care Act Implementation FAQs.
All material contained on this page is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated.
Content last updated: October 25, 2013.