HHS Issues Proposed Rule Expanding Contraception Coverage Without Cost-Sharing; Comments Due April 3
Published February 02, 2023
The Departments of Health & Human Services (HHS), Labor (DOL) and Treasury have proposed
rules that, if finalized, would amend regulations regarding coverage of
certain preventive services under the Patient Protection and Affordable
Care Act (ACA), which requires nongrandfathered group health plans and
nongrandfathered group or individual health insurance coverage to cover
certain contraceptive services without cost sharing.
Current
regulations (finalized in 2018) include exemptions and optional
accommodations for entities and individuals with religious or moral
objections to coverage of contraceptive services. These rules propose
rescinding the moral exemption rule.
According to the HHS fact sheet, these proposed rules would provide:
- A new independent pathway through which individuals enrolled in plans or coverage sponsored or arranged by objecting entities that have not opted for the existing accommodation (including those enrolled in individual health insurance coverage issued by such an objecting entity) could access contraceptive services at no cost. Specifically, these proposed rules would create a mechanism, independent from the employer, group health plan, plan sponsor, institution of higher education, or issuer, through which individuals could obtain contraceptive services at no cost from a willing provider of contraceptive services. This individual contraceptive arrangement would be available to the participant, beneficiary, or enrollee without the objecting entity having to take any action facilitating the coverage to which it objects.
- Through the individual contraceptive arrangement, a willing provider of contraceptive services would provide these services at no cost to individuals receiving them. The provider would be able to seek reimbursement for its costs from a participating qualified health plan (QHP) issuer in the Federally-facilitated Exchange (FFE) or State-based Exchange on the Federal platform (SBE-FP) with whom it has a signed agreement. To implement this, these proposed rules would amend current regulations so that an FFE or SBE-FP issuer that has agreed to reimburse a provider of contraceptive services that participates in the individual contraceptive arrangement would be eligible for an adjustment to the issuer’s FFE or SBE-FP user fee. This is the same user fee adjustment mechanism that currently exists for third party administrators in connection with the optional accommodation for self-insured group health plans.
Comments are due April 3, 2023.