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IRS and U.S. Preventive Services Task Force (USPSTF) Expand List of Preventive Care Benefits

USPSTF Expands ACA Preventive Care to Include HIV PrEP and BRCA Assessment

In June 2019, the U.S. Preventive Services Task Force (USPSTF) recommended an “A” rating for preexposure prophylaxis (PrEP), such as Truvada for PrEP®. Under the Affordable Care Act (ACA), group health plans must provide USPSTF “A” and “B” ratings to plan participants with no cost-sharing. The June 2019 USPSTF recommendations also included “A” ratings for HIV screening for adolescents, adults, and pregnant women. Additionally, in August and September, respectively, the USPSTF recommended a "B" rating for BRCA (BReast CAncer gene) assessment and genetic screening, as well as breast cancer risk-reducing medications for women who are at an increased risk for breast cancer.

No later than the next plan year that begins on or after one year from the recommendation date, plan sponsors must incorporate the new HIV and breast cancer preventive care recommendations into their plan design at no cost-sharing as it does with other preventive care under the ACA. Plans, however, may still impose certain reasonable medical management techniques such as requiring prior authorization. Employers should consult with their insurance carrier or third-party administrator to confirm that the new HIV preventive care recommendations are incorporated into its plan.

IRS Expands Chronic Condition Preventive Care Permissible with HSAs

In July 2019, the Internal Revenue Service (IRS) issued IRS Notice 2019-45 which expands the list of preventive care benefits a high deductible health plan (HDHP) can provide prior to satisfying the minimum deductible. The expanded list of chronic condition preventive care includes:

Preventive Care for Specified Conditions For individuals diagnosed with:
Angiotensin-Converting Enzyme (ACE) inhibitors Congestive heart failure, diabetes, and/or coronary artery disease
Anti-resorptive therapy Osteoporosis and/or osteopenia
Beta-blockers Congestive heart failure and/or coronary artery disease
Blood pressure monitor Hypertension
Inhaled corticosteroids Asthma
Insulin and other glucose-lowering agents Diabetes
Retinopathy screening Diabetes
Peak flow meter Asthma
Glucometer Diabetes
Hemoglobin A1c testing Diabetes
International Normalized Ratio (INR) testing Diabetes
Low-density Lipoprotein (LDL) testing Heart disease
Selective Serotonin Reuptake Inhibitors (SSRIs) Depression
Statins Heart disease and/or diabetes

According to the IRS,

“These specified services and items are treated as preventive care only when prescribed to treat an individual diagnosed with the associated chronic condition . . . and only when prescribed for the purpose of preventing the exacerbation of the chronic condition or the development of a secondary condition . . . However, services and items not listed . . . that are for secondary conditions or complications that occur notwithstanding the preventive care are not treated as preventive care.”

Employers should consult with their insurance carrier or third-party administrator to confirm that the new chronic conditions preventive care benefits are incorporated into its plan. Note, however, that this new guidance does not treat these services and items as required preventive care with no cost-sharing under the ACA.

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