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  • Washington Highlights

    HHS, Labor, and Treasury Propose Rule to Expand Coverage for Contraceptive Services

    Mary Mullaney, Director, Hospital Payment Policies
    Phoebe Ramsey, Director, Physician Payment & Quality
    Katherine Gaynor, Hospital Policy and Regulatory Analyst
    For Media Inquiries

    On Jan. 30, the U.S. departments of Health and Human Services (HHS), Labor, and the Treasury issued a proposed rule entitled Coverage of Certain Preventive Services Under the Affordable Care Act,aimed at strengthening access to contraception services coverage under certain plans in the Marketplace 

    Currently, certain plans (group health plans, institutions of higher education arranging student health insurance coverage, health insurance issuers, and individuals with religious or moral objections) are excluded from the requirement to provide coverage of contraceptive services. These entities can opt in to accommodations that allow individuals enrolled in their plans to access contraceptive services with no additional cost. However, if the entity does not opt in to this accommodation, then individuals enrolled in those plans do not have access to coverage without cost sharing.  

    The proposed rule would establish a new pathway referred to as an individual contraceptive arrangement that permits eligible individuals to voluntarily elect coverage of contraceptive services. This arrangement would allow individuals enrolled in plans or coverage sponsored by entities with exemptions that have not opted for accommodations to access contraceptive services at no cost directly from a willing provider or facility. Providers and facilities that choose to participate in the new pathway would be eligible for reimbursement by entering into a separate signed arrangement with an issuer on a federally facilitated exchange or state based exchange on the federal platform agreeing to provide contraceptive services with no cost sharing to enrollees covered under the exempted plans. The proposed rule would also remove the moral exemption rule that would allow for individuals and entities with a moral objection an exemption from mandated contraception coverage, but leaves the religious exemption in place for individuals and entities and the optional accommodation.