October 22, 2024  – The Departments of Health and Human Services, Labor, and Treasury announced proposed rules on October 21, 2024, aimed at expanding coverage of preventive services under the Affordable Care Act
(ACA).

Since its enactment in 2010, the ACA has mandated that non-grandfathered health plans cover certain
recommended preventive services without imposing any cost-sharing requirements. These services range from screenings and immunizations to preventive care for women and children. Over the years, however, the need to address gaps has become apparent. This has led to the proposed regulatory amendments announced recently.

Key Proposals to Enhance Preventive Service Coverage
The proposed regulations aim to refine how health plans cover preventive services and communicate benefits to consumers. One of the pivotal changes includes an enhanced exceptions process that would
allow individuals to access necessary preventive services as determined medically appropriate by their
providers, without cost-sharing constraints.

Focus on Contraceptive Coverage
A significant aspect of the proposed rules is the emphasis on improving access to contraceptive services.
The new rules would require plans to cover recommended OTC contraceptive items without the need
for a prescription and free of cost-sharing. This move is designed to align more closely with statutory
requirements and aims to remove significant barriers that currently prevent easy access to
contraceptives.

In addition to expanding coverage, the proposed rules also emphasize improving transparency. Plans
and issuers would be required to include clear disclosures in their coverage tools, explaining that OTC
contraceptive items are covered without needing a prescription and providing additional resources for
enrollees to understand their benefits better.

Public Comments and Future Directions
The proposed rules are open for public comment for 60 days following their publication in the Federal
Register, inviting feedback from various stakeholders. This period is crucial for addressing potential
concerns and gathering diverse perspectives on how best to implement these changes effectively.
If finalized, these rules would not only mark a substantial shift towards more inclusive health coverage
but also set a precedent for future enhancements in preventive healthcare. The Departments have
expressed their commitment to continuing this momentum, with plans to issue further rulemakings to
expand the coverage of preventive services comprehensively.

To read more about the specifics of the proposed changes, the full text of the proposed rules is available
on the Federal Register’s website.