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Home ACA Compliance 4 Ways ACA Preventive Care Provisions Will Change if New Proposed Rules Pass

4 Ways ACA Preventive Care Provisions Will Change if New Proposed Rules Pass

3 minute read
by Robert Sheen
ACA preventive care

A set of proposed rules issued by the Internal Revenue Service, Employee Benefits Security Administration, the Centers for Medicare and Medicaid Services, earlier this month aims to expand free access to preventive health services under the ACA.

Section 2713 prescribes Patient Protection and ACA preventive care requirements, ensuring that covered individuals can obtain certain health services without a copayment or deductible – however, there is currently an exemption for employers who are opposed to providing these services to employees based on moral and or religious reasons.

If the proposed rules become final, four key changes to preventive care services would follow:

  1. Rescind the moral exemption rule, which includes exemptions and optional accommodations for entities and individuals with religious or moral objections to coverage of contraceptive services 
  2. Establish a new individual contraceptive arrangement that individuals enrolled in plans or coverage sponsored, arranged, or provided by objecting entities may use to obtain contraceptive services at no cost directly from a provider or facility that furnishes contraceptive services
  3. Make contraceptive services available through the proposed individual contraceptive arrangement without any involvement on the part of an objecting entity
  4. Reimburse providers or facilities that furnish contraceptive services in accordance with the individual contraceptive arrangement for eligible individuals by entering into an arrangement with an issuer on a Federally-facilitated Exchange or State Exchange on the Federal platform, which in turn may seek a user fee adjustment

The agencies are currently accepting public comments and will continue to do this through April 3, 2023. The changes would ensure access to important preventive care services, including birth control, and other contraceptives. 

CMS Administrator Chiquita Brooks-LaSure, said regarding the possibility of the rules becoming final, “If this rule is finalized, individuals who have health plans that would otherwise be subject to the ACA preventive services requirements but have not covered contraceptive services because of a moral or religious objection, would now have access.

Meanwhile, a pending lawsuit in Texas illuminates the need for the proposed amendments. The case alleges that preventive care provisions of the ACA are unconstitutional. Judge Reed O’Connor, the same Judge who previously ruled the ACA unconstitutional without the Individual Mandate, is expected to make a decision on the case soon, which will potentially affect the coverage of services such as mammograms and diabetes screenings. 

If passed, the proposed rulemaking would eliminate threats like this by strengthening ACA coverage and preventing employers and health carriers alike from picking and choosing which services should be covered.

Other government efforts to eliminate healthcare discrimination are cropping up. Last year, CMS issued a notice of proposed rulemaking for the ACA’s Section 1557 to ensure that individuals can receive federally funded healthcare assistance and program support without discrimination, particularly for reproductive healthcare services. 

It’s evident that blockers to the ACA may continue to surface, but recent reports show the ACA is the strongest it’s ever been. Federal action to combat discrimination and bolster provisions for preventive care demonstrates how entrenched the law is into the U.S. healthcare system–and that it isn’t going anywhere.

With ACA enrollment at an all-time high, employers should be mindful of possible risks under the law’s Employer Mandate. The penalties for non-compliance continue to rise, posing more and more of a significant financial risk to employers. Knowing your compliance risk level is the first step to protecting your organization. Get your ACA Vitals score in seconds below.

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