18 Apr 2023
Just Leave Me Alone! Texas Court (Again) Takes an Axe to the ACA
If the Affordable Care Act (ACA) were a tree, it would bear the marks of the swings taken at dismantling or disassembling it. From outright repeal, elimination of the individual taxpayer mandate, and now to eliminating goods and services treated as “preventive care,” the law stands, but is bruised with every swing. Last month, a Texas judge invalidated the no cost coverage of preventive health services under the ACA indicating that insurance plans nationwide do not have to comply with ACA's preventive services mandate recommended by the U.S. Preventive Services Task Force, as the judge said the members of that task force were unlawfully appointed. Braidwood Mgmt. Inc. v. Becerra, 2023 U.S. Dist. LEXIS 54769. The decision additionally broadened a religious objector objection to HIV prevention medication. The Justice Department is expected to appeal the decision and ask for a stay on its implementation while the case goes through the courts.
Related Content
- ACA Preventive Services Coverage Rules
ACA added Section 2713 to the Public Health Service Act, as incorporated into ERISA and the Internal Revenue Code requiring non-grandfathered group health plans and health insurance coverage to provide certain specified preventive health services without cost sharing. As amended by the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136), group health plans and insurance policies subject to ACA’s preventive services rules were required to treat certain qualifying coronavirus-related items and services as preventive services (including tests and vaccines). Pub. L. No. 116-136, § 3203.
Legal Developments
- Code Section 457(f) Conundrum: How to Handle Past-Year Mistakes (from Vesting)
Salary reduction contributions under a Section 457(f) plan, which only applies to governmental entities and tax-exempt organizations, are subject to a special rule generally requiring that participants recognize ordinary income whenever their plan benefits are not subject to a substantial risk of forfeiture. - Court Overturns Guidance in DOL Rollover Advice
A Florida district court vacated part of the 2021 Department of Labor (DOL) rollover guidance on investment advice fiduciaries (Am. Sec. Ass'n v. DOL, 2023 U.S. Dist. LEXIS 24076 (M.D. Fla. Feb. 13, 2023)). In one of its FAQs, DOL had said a recommendation to rollover a participant's retirement plan account to an IRA may be fiduciary investment advice when the advisor expects to give ongoing advice after the rollover. - Fraud, Waste, and Abuse: Spotlight on Ancillary Services
See how managed care companies can minimize risk from providers engaging in fraudulent, abusive, and wasteful health care services and billing.
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