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  • Washington Highlights

    AAMC Comments on Coverage of Preventive Services Under ACA

    Mary Mullaney, Director, Hospital Payment Policies
    Phoebe Ramsey, Director, Physician Payment & Quality
    For Media Inquiries

    On April 3, the AAMC submitted comments on the proposed rule issued by the Centers for Medicare & Medicaid Services and the departments of Health and Human Services, Labor, and the Treasury. The proposed rule seeks to ensure coverage of and access to preventive services, specifically women’s preventive services. The proposal would create an “individual contraceptive arrangement” that would provide contraceptive coverage for individuals enrolled in group health plans or health insurance coverage through an objecting entity that claims the religious exemption without voluntarily using the accommodation process. The AAMC supports the proposal.  

    Federal regulations allow an exemption to coverage of contraceptive services for entities and individuals with religious objections. Regulations also provide an optional accommodation for objecting entities to remove themselves from providing contraceptive coverage while ensuring individuals enrolled in their plans can access such services at no additional cost. As noted in the proposed rule, this accommodation was “designed so that these entities were not required to contact, arrange, pay, or provide a referral for contraceptive coverage” in line with their religious objection. This accommodation is entirely voluntary, resulting in many individuals covered by objecting entities unable to access contraceptive benefits without cost sharing as guaranteed by the Affordable Care Act (ACA). 

    Under the proposed arrangement, individuals would be able to have access, at no cost, to all contraceptive services their plan would otherwise be required to cover, absent the exemption. A provider furnishing the contraceptive services under this arrangement would do so outside of the patient’s insurance coverage and would not impose any cost sharing or collect any reimbursement from the patient. Participation in an individual contraceptive arrangement would be voluntary for the provider. The provider would enter into an agreement with a participating issuer of a qualified health plan (QHP) and would be permitted to seek reimbursement from that issuer for the services provided. The provider must have a signed agreement with the QHP issuer defining the costs of providing contraceptive services to women covered under these objecting plans.  

    The AAMC supports proposals that continue to provide access to these critical preventive services for individuals whose insurance plans does not provide coverage. Further, the association supports allowing providers to directly contract with QHP issuers to seek reimbursement for these services.