New Preventive Services Requirements Include Religious Exemption For Contraceptive Services

from Spencer’s Benefits Reports: On August 1, the Department of Health and Human Services’ Health Resources and Services Administration (HRSA) announced new guidelines for providing preventive services to women, which include some exemptions for religious employers.

The guidelines follow closely the recommendations published last month from the Institutes of Medicine, which add eight preventive health services for women, which health plans must cover at no cost to patients, under Public Health Service Act Sec. 2713, as added by the Patient Protection and Affordable Care Act (ACA).

The HRSA guidelines also adopt regulatory provisions published in the August 3 Federal Register, which provide exemptions for religious employers where contraceptive services are concerned.

New health plans will need to include these services without cost-sharing for insurance policies with plan years beginning on or after Aug. 1, 2012. The rules governing coverage of preventive services allow plans to use reasonable medical management to help define the nature of the covered service. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.

The new HRSA guidelines are available at http://www.hrsa.gov/womensguidelines/.

Religious Exemption

The religious exemption for contraceptive services is included in an interim final rule from the Internal Revenue Service, the Employee Benefits Security Administration (EBSA), and the Centers for Medicare and Medicaid Services (CMS).

Under the interim final rule, group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.

A religious employer is one that meets all of these criteria:

      (1) has the inculcation of religious values as its purpose;
      (2) primarily employs persons who share its religious tenets;
      (3) primarily serves persons who share its religious tenets; and
      (4) is a nonprofit organization under IRC Secs. 6033(a)(1) and 6033(a)(3)(A)(i) or (iii).

The interim final rule is effective August 1. The rule waives a normal 30-day delay in the effective date in order for some college students to take advantage of the new preventive care rules in the 2012-13 school year. According to the rule, “Many college student policy years begin in August. Delaying the effective date of this amendment by 30 days would mean that the HRSA guidelines could not be issued until after August of 2011. This delay would mean many students could not benefit from the new prevention coverage without cost-sharing following from the issuance of the guidelines until the 2013-14 school year, as opposed to the 2012-13 school year.”

Comments are due 60 days after publication in the Federal Register and should be sent via the Federal eRulemaking Portal at http://www.regulations.gov. Comments to the EBSA should be identified by RIN 1210- AB44; comments to the CMS should be identified by CMS-9992- IFC2; comments to the IRS should be identified by identified by REG-120391-10.

For more information, contact Amy Turner or Beth Baum, EBSA, at (202) 693-8335; Karen Levinm IRS, at (202) 622-6080; or Robert Imes, CMS, at (410) 786-1565.