Richard H. Hughes, IV, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in AIS Health, in “CMS Signals Preventive Services Coverage Update with Pending Rule,” by Richard Scott. (Read the full version – subscription required.)
Following is an excerpt:
Changing coverage requirements for a slew of preventive services may be coming to health plans, as CMS eyes an update to Affordable Care Act provisions that may eventually extend to insurance markets beyond the federal and state marketplaces.
On August 30, a new proposed rule, Enhancing Coverage of Preventive Services under the Affordable Care Act, was posted to the Office of Management and Budget’s (OMB) dashboard.
The release date of the rule remains uncertain, but it may contain new coverage requirements for preventive services such as contraceptive care and vaccines, Richard Hughes IV, health care lawyer with Epstein Becker Green in Washington, D.C., tells AIS Health, a division of MMIT. …
After a decision from the U.S. Court of Appeals for the Fifth Circuit in June failed to resolve the Braidwood suit, the Dept. of Justice (DOJ) is pushing for the Supreme Court to take up the case, according to Hughes. The DOJ’s petition to the Supreme Court is due by Sept. 19, and the case is likely to be considered between that date and the Thanksgiving holiday, he adds. …
Hughes points out that the new proposed rule, which would come with a comment period before the release of a final rule, will be issued solely by CMS. Prior rules addressing ACA-related preventive services, including a 2023 version that fizzled out, have been co-presented by the Dept. of Labor and the Treasury Dept.
The fact that CMS is the lone backer “could indicate it is limited in applicability to the marketplace rather than the entire commercial market,” Hughes says, though he adds that the scope of coverage requirements remains unclear. “Maybe CMS is putting it forward and the other agencies will join in,” he says. …
Among other possible targets for CMS, Hughes hopes that the agency will clarify the scope of immunization policies. “The current language is confusing,” he says. The use of the term “routine immunizations” in ACA parlance has muddied the coverage requirements for as long as the ACA has been around, Hughes says. Because the ACA speaks more to “whole groups of people at large” for eligibility criteria, it can miss the “individualized risk factors” that might make more sense for the broad roster of immunizations and screenings.
CMS has “a lot of opportunity to improve access, remove barriers and improve clarity,” Hughes says. …
