Reed Smith Client Alerts

The March 30, 2023 decision in Braidwood Management Inc. v. Becerra significantly impacted plan coverage requirements by invalidating federal mandates for many preventative care services. In response, on April 13, 2023, the Departments of Labor, Health and Human Services, and the Treasury (Departments) issued FAQs to clarify the impact of this decision. This alert provides a summary of current coverage requirements in light Braidwood and recent federal guidance, and highlights lingering uncertainty regarding the impact of this decision.

The United States District Court for the Northern District of Texas ruling in Braidwood prevents federal enforcement of any preventive care no-cost coverage requirements recommended with an “A” or “B” rating by the United States Preventive Services Task Force (USPSTF) on or after March 23, 2010 (i.e., after the passage of the Affordable Care Act). USPSTF is one of three agencies that determines the preventative care that must be covered without cost-sharing; the other two are the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA), whose recommendations are not impacted by this ruling. The court’s decision as to the USPSTF was based on the finding that its members were not appointed in accordance with the Appointments Clause of the United States Constitution, which rendered all of the USPSTF’s preventive care recommendations unlawful. Preventive services affected by this ruling include HIV pre-exposure prophylaxis (PrEP), drugs that reduce the risk of breast cancer, lung cancer screening, and hepatitis C screening (a complete list is available here). The Departments have filed a notice of appeal and a motion for a stay in the Fifth Circuit.