Preventive Care Mandate Returned to Status Quo — Temporarily

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Seyfarth Synopsis: The 5th Circuit Court of Appeals has stayed enforcement of a Texas federal district court ruling that voided the ACA requirement for health plans to cover preventive care items and services (without cost sharing) recommended by the United States Preventive Services Task Force (“USPSTF”) effective as of March 23, 2010.

Just months after a Texas federal district court enjoined enforcement of the preventive care mandate for items and services with an “A” or “B” rating recommended by the USPSTF, the 5th Circuit Court of Appeals has issued a stay order which freezes the effect of the ruling. Until the appeal is resolved, health plans must continue to comply with the Affordable Care Act’s preventive care mandate as it applied prior to the district court decision. Plan sponsors should not make changes to their plans’ coverage for preventive care items and services with an “A” or “B” rating recommended by the USPSTF until the appeal has made its way through the courts and a final decision has been rendered by the 5th Circuit.

For more details on the original district court decision or subsequent FAQs issued by the Tri-Agencies, please see our prior blog posts here and here. We will continue to monitor the case and its impact on plans. Stay tuned!

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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