How the Braidwood decision impacts preventive care
Published on April 20th, 2023
Recently, the U.S. District Court of the Northern District of Texas ruled that the recommendations made by the U.S Preventive Services Task Force (USPSTF) regarding what services were considered preventive care under the Affordable Care Act (ACA) were unconstitutional regarding the court decision in Braidwood Management Inc. v. Becerra. Accordingly, the Court vacated all actions taken by the Departments of Labor, Treasury and Health (the Agencies) to implement and enforce certain aspects of the ACA’s preventive service coverage requirements.
Here’s a summary of what you need to know regarding how this court ruling affects preventive care and health plans regulated by the Agencies, further explained in this FAQ:
- For the time being, the Braidwood decision will have no effect on HSAs.
- The ruling prevents the Departments from implementing and enforcing PHS Act section 2713(a)(1)’s coverage requirements for items and services recommended with an “A” or “B” rating by the USPSTF on or after March 23, 2010. However, the Departments strongly encourage plans and issuers to continue to cover such items and services without cost sharing.
- Plans and issuers must continue to cover such items and services as immunizations recommended by ACIP, contraceptive services, breastfeeding services and supplies, cervical cancer screening, and pediatric preventive care recommended by HRSA.
- The Braidwood decision generally does not affect the application of state laws that require health insurance issuers offering group or individual health insurance coverage to provide coverage without cost sharing of items and services.
- Plans and issuers are not required to make any changes to coverage or cost sharing as a result of the Braidwood decision, and the Departments strongly encourage plans and issuers to continue to cover, without cost sharing, items and services affected by the court’s decision. Plans and issuers, including self-insured plans, may still be required to cover the full scope of recommended preventive services under other legal and contractual requirements.
- The plan or issuer must comply with applicable notice requirements when making any changes to the terms of coverage with respect to items and services recommended by the USPSTF.
- An HDHP may provide preventive care benefits without a deductible or with a deductible below the minimum annual deductible under Code section 223(c)(2)(C). Preventive care also includes preventive services required to be covered by a plan or issuer without the imposition of cost-sharing requirements under PHS Act section 2713.
- Items and services recommended with an “A” or “B” rating by the USPSTF on or after March 23, 2010, will be treated as preventive care, regardless of whether these items and services must be covered, without cost sharing, under PHS Act section 2713.