HHS Revises ACA Contraception Coverage Requirements

The Obama Administration has issued two regulations addressing coverage of contraceptive services under QHPs in response to recent court rulings (in particular the Supreme Court ruling in Burwell v. Hobby Lobby Stores, Inc.) addressing certain religious objections to such coverage. First, an interim final rule provides an additional pathway for nonprofit organizations eligible for a religious accommodation to provide notice of their religious objection to covering contraceptive services. These eligible organizations are permitted to notify the Department of Health and Human Services (HHS) in writing of their religious objection to providing contraception coverage. HHS and the Department of Labor will in turn notify insurers and third party administrators so the organization’s enrollees will receive separate coverage for contraceptive services, with no additional cost to the enrollee or the employer. The interim final rule is effective August 27, 2014; comments will be accepted until October 27, 2014.

The Administration also published a related proposed rule that would extend to certain “closely-held” for-profit entities (such as Hobby Lobby) the same accommodation that is available to non-profit religious organizations with religious objections to coverage of contraceptive services. Under the proposed rule, these companies would not be required to contract, arrange, pay or refer for contraceptive coverage to which they object on religious grounds. Payments for contraceptive services provided to participants and beneficiaries in the eligible organization's plan would be provided separately by an issuer or arranged separately by a third party administrator, consistent with existing regulations for certain religious employers. Comments on the proposed rule are due by October 21, 2014.

Obama Administration Finalizes Revised ACA Contraceptive Coverage Requirements

HHS, together with the Departments of Treasury and Labor, published a final rule on July 2, 2013 that modifies the Administration’s policy on the extent to which group health plans established by certain religious employers must cover contraceptive services without cost sharing. In short, the rule is intended to simplify the definition of a “religious employer” as it relates to contraceptive coverage to provide that an otherwise exempt plan is not disqualified because the employer's purposes extend beyond the inculcation of religious values or because the employer serves or hires people of different religious faiths. Consistent with the February 6, 2013 proposed rule, the final rule establishes accommodations for health coverage established or maintained by eligible non-profit religious organization, or arranged by eligible organizations that are religious institutions of higher education, with religious objections to contraceptive coverage. Affected plan participants will receive contraceptive coverage through separate individual health insurance policies, without cost sharing or additional premiums; the mechanisms for this coverage varies based on the type of plan. The final rule is effective on August 1, 2013. With the exception of the amendments to the religious employer exemption, which apply to group health plans and health insurance issuers for plan years beginning on or after August 1, 2013, these final regulations apply to group health plans and health insurance issuers for plan years beginning on or after January 1, 2014.

CMS Provider Call on New Medicare Preventive Services (August 15)

CMS has scheduled an August 15, 2015 national provider call on new Medicare preventive services. The call will cover the following five benefits: Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse; Screening for Depression in Adults; Intensive Behavioral Therapy for Cardiovascular Disease; Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs; and Intensive Behavioral Therapy for Obesity.

National Prevention Council Action Plan Released

On June 13, 2012, the National Prevention Council released the “National Prevention Council Action Plan,” which outlines specific steps the Administration is taking to implement the strategic directions and priorities of the National Prevention Strategy.

CMS Call on Medicare Preventive Services (March 28)

On March 28, 2012, CMS is hosting a national provider call on Medicare Preventive Services: the Initial Preventive Physical Exam (IPPE) and Annual Wellness Visit (AVW). CMS experts will discuss both the IPPE and AWV, including when to perform them, who can perform each service, who is eligible, and how to code and bill for each service, followed by a question and answer session. Registration is required. 

White House Announces Change to Rules Regarding Coverage of Contraceptive Services for Certain Religious Groups

As previously reported, last month HHS Secretary Kathleen Sebelius announced that certain religious employers who currently do not provide coverage for contraceptive services under their insurance plan will be required to do so beginning August 1, 2013. An exception from the mandate was provided only to non-profit religious employers that: have the inculcation of religious values as their purpose; primarily employ persons who share their religious tenets; and primarily serve persons who share their religious tenets. In response to concerns raised by religious groups that the exception would not extend to church-affiliated universities, hospitals, and other entities, the Obama Administration announced on February 10, 2012 that objecting non-profit religious employers will not have to provide contraceptive coverage or refer women to organizations that provide contraception, but the employee’s insurance company will be required to directly offer the employee contraceptive care free of charge. Details regarding this policy will be developed through rulemaking.  A notice of the policy is scheduled to be published on February 15.

HHS Amends ACA Preventive Services/Contraception Coverage Rules

On August 3, 2011, the HHS published an interim final rule with comment period amending rules regarding coverage of certain preventive services by group health plans and health insurance coverage in the group and individual markets under the ACA. As previously reported, HHS announced earlier this month that health plans will be required to furnish certain preventive health services, including contraceptive services, for women without cost sharing under the ACA, effective for plan years beginning on or after August 1, 2012.  The August 3 rule provides the Health Resources and Services Administration (HRSA) with additional discretion to exempt certain religious employers from HRSA preventive guidelines with regard to contraceptive services. Under the rule, a religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization. HHS will be accepting comments on this definition as well as alternative definitions.   The interim final regulations are effective August 1, 2011, although comments will be accepted until September 30, 2011. 

IOM Issues Recommendations for Women's Clinical Preventive Services

The Institute of Medicine recommended to the HHS Secretary that eight additional preventive services for women be added to the preventive services that health plans cover at no cost to the patient under the ACA. The eight services include:  screening for gestational diabetes; human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30; counseling on sexually-transmitted infections; counseling and screening for HIV; contraceptive methods and counseling to prevent unintended pregnancies; lactation counseling and equipment to promote breast-feeding; screening and counseling to detect and prevent interpersonal and domestic violence; and yearly well-woman preventive care visits to obtain recommended preventive services.

CMS Call "The ABCs of the Initial Preventive Physical Examination and Annual Wellness Visit" (July 21)

CMS is hosting a provider call on July 21, 2011 to provide an overview of Medicare coverage for an Initial Preventive Physical Examination (commonly known as the "Welcome to Medicare" Visit) and the Affordable Care Act’s Annual Wellness Visit. Registration for the call will close at 1:30 pm on July 20 or when available space has been filled.

National Prevention Strategy Unveiled

The National Prevention, Health Promotion, and Public Health Council has released its final “National Prevention and Health Promotion Strategy,” as mandated by the ACA. The strategy identifies four “strategic directions” for improving the nation’s health: building healthy and safe community environments; expanding quality preventive services in both clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. The document also makes recommendations to address seven priority areas for improving the health and wellness of the U.S. population: tobacco free living; preventing drug abuse and excessive alcohol use; healthy eating; active living; injury and violence free living; reproductive and sexual health; and mental and emotional well-being.

CMS Proposes Influenza Vaccination Standard for Medicare/Medicaid Providers and Suppliers

On May 4, 2011, CMS published a proposed rule that would require certain Medicare and Medicaid providers and suppliers to offer all patients an annual influenza vaccination, unless medically contraindicated or unless the patient (or patient's representative or surrogate) declines vaccination. The requirement would apply to the following entities: hospitals (all types that participate in Medicare); CAHs; rural health clinics; Federally Qualified Health Centers, and end-stage renal disease facilities. These providers and suppliers have been proposed because: (1) in each setting, the patient presents before health care providers with staff licensed to provide vaccination at the time and location of the encounter; and (2) all have ready access to equipment and storage appropriate for handling, controlling, and administering vaccines. The proposed rule also would require the specified providers and suppliers to develop policies and procedures that would allow them to offer vaccinations for pandemic influenza, in case of a future pandemic influenza event for which a vaccine may be developed. CMS will accept comments on the proposal until July 5, 2011. CMS expects to adopt a final rule in the early fall of 2011 that would be in effect during the 2011-2012 influenza season.

House Passes Bill to Cut ACA Prevention Fund

On April 13, 2011, the House of Representatives approved H.R. 1217, a bill to repeal the ACA’s Prevention and Public Health Fund, which is a discretionary fund for investment in prevention and public health programs. The bill now moves to the Senate, where it is unlikely to be considered. The White House also has issued a statement opposing the bill.

House Panel Approves Bills to Roll Back Certain ACA Funding

On April 5, 2011, the House Energy and Commerce Committee approved a series of health policy bills, including H.R. 1217, a bill to repeal the Prevention and Public Health Fund (a discretionary fund for investment in prevention and public health programs); and H.R. 1213, a bill to repeal mandatory funding provided to states to establish American Health Benefit Exchanges under the ACA. The full House is scheduled to vote on H.R. 1217 on April 13, 2011.

Comments Requested on Value-Based Insurance Design for ACA Preventive Care Benefits

On December 28, 2010, the Obama Administration published a request for information regarding how group health plans and health insurance issuers can employ value-based insurance design in the coverage of recommended preventive services. The notice seeks information on, among other issues: specific plan design tools to incentivize patient behavior; how to identify high-value treatment settings, providers, and delivery mechanisms; and ways to ensure that patients with particular co-morbidities or other special circumstances receive the medically-appropriate level of care. Comments are due February 28, 2011.

HHS Announces Health Promotion/Disease Prevention Agenda

On December 2, 2010, HHS released Healthy People 2020,” which sets forth new 10-year goals and objectives for national health promotion and disease prevention. The document includes a greater focus on identifying, measuring, tracking, and reducing health disparities through a “determinants of health” approach that examines the range of personal, social, economic, and environmental factors that influence health status. New topic areas for 2020 include, among others, genomics, healthcare-associated infections, and health incident preparedness.  HHS also announced a contest for technology application developers to design platform-neutral applications to provide Healthy People stakeholders (e.g., professionals and advocates) with easy access to a comprehensive suite of information resources to maximize their success in achieving Health People objectives. The application deadline is March 7, 2011. 

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