Temporary Stay Issued in Court Ruling That Puts No Cost Preventive Health Coverage in Jeopardy
Certain health plan requirements to cover preventive care services at no cost to enrollees are in jeopardy as a result of the Texas court ruling in Braidwood Management, Inc. v. Becerra. However, a temporary stay granted by an appeals court creates even more uncertainty over the enforceability of certainty preventive care requirements going forward.
For background, the ACA required employer plans to cover the following preventive care services without cost sharing:
- Services receiving an “A” or “B” rating by the US Preventive Services Task Force (USPSTF)
- Immunizations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP)
- Services and screenings for women and children provided in guidelines issued by the Health Resources and Services Administration (HRSA)
The Braidwood ruling was specific only to the USPSTF, finding that its ongoing authority to define preventive care was improperly granted to a task force that is not a federal agency with properly appointed members. However, USPSTF preventive care requirements that were in place before the ACA was signed into law on March 23, 2010, or those determined by ACIP and HRSA, will continue to be in place even if the ruling ultimately wins in court.
The federal government responded to the ruling by filing an appeal and asking for a stay - a pause on the decision pending further court action. The stay that was granted is only a temporary one, giving the court time to consider the merits of issuing a longer term stay or removing it altogether and allowing the lower court’s decision to take effect. Understandably, employers cannot be certain if they should take advantage of the additional flexibility granted by the initial decision to design their own preventive care benefits (which would require a 60-day notice if implemented mid-plan year), and the situation may remain legally fluid for some time.
Federal agencies have also issued Frequently Asked Questions related to preventive care coverage requirements that can be found here. It clarifies that the ruling does not apply to any recommendations made by ACIP or HRSA, and that federal agencies will issue additional guidance to clarify how plans should cover preventive services that were modified by the USPSTF after March 23, 2010. As you can see from this tracker created by the Kaiser Family Foundation, several preventive care recommendations were modified by the USPSTF on or after March 23, 2010.
The FAQs also clarify the ruling’s impact on preventive care services provided pre-deductible for the purposes of HSA rules. The agencies state that USPSTF preventive care recommendations in place today will continue to be considered preventive care under HSA-eligible High Deductible Health Plans “until further guidance is issued.”
House Committees Hold Hearings on Health Costs
The U.S. House Committee on Education and Workforce Subcommittee on Health, Employment, Labor and Pensions held a hearing on April 26th called “Reducing Health Care Costs for Working Americans and their Families.” A video replay can be viewed here, starting at the 16:30 mark. That same day, the House Energy and Commerce Health Subcommittee held a hearing titled “Lowering Unaffordable Costs: Legislative Solutions to Increase Transparency and Competition in Health Care.” That hearing can be viewed here and begins at the 6:33 mark.
CMS Updates Hospital Price Transparency Enforcement
The Center for Medicaid and Medicare Services (CMS) has issued an update on its enforcement of hospital transparency requirements, saying it has taken steps to shorten the average time by which hospitals must come into compliance with the requirements after a deficiency is identified. CMS also says it has issued 730 warning notices and 269 requests for corrective action plans from hospitals and has imposed civil monetary penalties on four hospitals to date.