Agencies Issue FAQs (Part 51) With ACA Preventive Health Services Guidance

The DOL, IRS, and HHS have issued FAQs Part 51. While six of the FAQs provide anticipated guidance on plan coverage of over-the-counter COVID-19 tests (see our Checkpoint article), three FAQs address issues relating to the Affordable Care Act (ACA) preventive health services requirements. Here are highlights of the preventive services guidance:

• Colonoscopies. Q/A-7 advises that a group health plan or insurer must cover, without cost-sharing, a colonoscopy conducted after a positive non-invasive stool-based screening test or direct visualization screening test for colorectal cancer, consistent with the May 18, 2021 United States Preventive Services Task Force (USPSTF) recommendation. Q/A-8 adds that the USPSTF recommendation is considered to have been issued as of May 31, 2021, so coverage without cost-sharing must be provided for plan or policy years beginning on or after May 31, 2022 (one year after the date the recommendation was issued).
• Contraceptives. Pointing to complaints and reports that group health plans and insurers are not complying with the contraceptive coverage mandate as amplified by Health Resources and Services Administration (HRSA) guidelines, Q/A-9 cautions that the agencies are actively investigating compliance with this requirement and may take enforcement or other corrective actions. Furthermore, the agencies are assessing what types of changes to existing guidance may be needed to ensure that individuals receive the mandated coverage. Q/A-9 also notes that the agencies have received feedback that the current FDA birth control guide referenced in the HRSA guidelines may not identify newer or all contraceptive products approved, cleared, or granted by the FDA. The agencies warn that, as a result, plans and insurers may not be providing coverage for the full range of FDA-approved, cleared, or granted contraceptive products in accordance with the current 2019 HRSA guidelines.

EBIA Comment: These FAQs illustrate that employers and their advisors need to be vigilant to stay on top of the preventive health services requirements for group health plans. Lists of the current USPSTF recommendations and HRSA guidelines are available online and are continually updated. For more information, see EBIA’s Group Health Plan Mandates manual at Section XIV.C (“Required Preventive Health Services Coverage”) and EBIA’s Health Care Reform manual at Section XII.C (“Coverage of Preventive Health Services”). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1 (“Preventive Health Services”).

Contributing Editors: EBIA Staff.