June 07, 2023
The U.S. Preventive Services Task Force (USPSTF) updated a recommended preventive service for screening for latent tuberculosis infection (LTBI) in adults. The updated recommendation replaces, but is generally consistent with, the prior 2016 recommendation. The Affordable Care Act (ACA) requires that most group health plans cover all preventive services with an “A” or “B” rating from the USPSTF without cost sharing (i.e., no copay, coinsurance, or deductible). Group health plans (with few exceptions) must cover this service effective for plan years beginning on or after May 2, 2024 (January 1, 2025 for calendar year plans).
Key Action
Continue covering USPSTF “A” and “B” rated preventive services without cost-sharing.
Business Group on Health has covered the ongoing Braidwood Management v. Becerra (Braidwood) litigation challenging the constitutionality of the USPSTF and ACA preventive services coverage requirements during our September 2022 and April 2023 Regulatory & Compliance webinars. As a brief summary:
- The U.S. District Court for the Northern District of Texas ruled that the appointment of the USPSTF violated the “Appointments” clause of the Constitution because the members of the task force were not properly appointed.
- The court’s ruling blocking the requirement nationwide that applicable plans and health insurance issuers cover preventive services recommended or updated by the USPSTF on or after March 23, 2010. Following the district court’s ruling,
- The Department of Labor Employee Benefits Security Administration (DOL/EBSA), Department of Health and Human Services (HHS), and Department of Treasury (collectively, the Departments) issued Affordable Care Act (ACA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act Implementation FAQs Part 59 addressing the impact of the district court’s ruling.
At the time of writing, the U.S. 5th Circuit Court of Appeals has issued an administrative stay of the federal district court’s ruling. Therefore, as the litigation proceeds, employer plan sponsors must continue to cover USPSTF “A” and “B” rated services without cost sharing. Business Group on Health will keep members informed of legal and regulatory developments.
Resources
- USPSTF Final Recommendation Statement – Latent Tuberculosis Infection in Adults: Screening
- USPSTF List of “A” and “B” Recommendations
If you have questions, comments, or concerns about these or other regulatory and compliance issues, please contact us.
We provide this material for informational purposes only; it is not a substitute for legal advice.
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