The DOL, HHS, and Treasury have issued FAQs in response to the Braidwood case. In that case, a Texas federal judge declared the ACA requirement to provide preventive care on a no-cost basis unconstitutional. This raised a plethora of questions about how preventive care can be covered and what actions plans can/must take in providing preventive care coverage.
The bulk of the FAQs provided clarity on issues that are fairly straightforward. However, in welcome news, important clarification was provided to confirm that plans can continue to cover preventive care under HDHPs (as before).
Special Rule for Preventive Care under HDHPs
Can a plan continue to offer preventive care on a pre-deductible basis?
Yes. Until further guidance is issued, preventive care services previously recommended with an "A" or "B" rating by the U.S. Preventive Services Task Force (USPSTF) on or after March 23, 2010, will be treated as preventive care for purposes of HDHP/HSA plan rules. This applies regardless of whether these items and services would otherwise not be considered qualified preventive care under an HDHP. This means that HDHP plans do not need to be immediately amended, that preventive care coverage can continue as is and that retaining such a plan design will not compromise participants’ ability to make HSA contributions.
Super Short Summary
The full text of the FAQs can be reviewed here, but a super short summary of key questions and answers is provided below for easy reference:
Does it apply to all preventive care?
No. It only applies to services receiving an “A” or “B” rating by the U.S. Preventive Services Task Force AFTER March 23, 2010. Services deemed preventive care prior to that time or by an agency other than the USPSTF are not impacted. The departments recognize that pre/post decisions are not clear at this time and will be providing additional guidance on this.
What about immunizations and well-child/well-woman care?
These services are not impacted by the Braidwood case (because they were not deemed preventive care by the U.S. Preventive Care Task Force). Therefore, they must continue to be covered. Such services include immunizations, contraceptive services, breastfeeding services and supplies, cervical cancer screening, and pediatric preventive care.
If plan changes are made, do participants need to be notified?
Yes, if plan provisions are changed, plans must comply with all regular participant notice procedures.
